An independently-funded study on the impact of older and newer antipsychotic drugs, published in the Archives of General Psychiatry, has found that the older and cheaper drugs seem to lead to
a better an equal quality of life.
Antipsychotics are generally used to treat delusions and hallucinations in a number of mental disorders, but are most used by people diagnosed with schizophrenia.
The study has caused barely a whisper in the mainstream media but is interesting for a number of reasons.
The first is that it was not funded by a drug company. Studies funded by the pharmaceutical industray are more likely to report favourable results, so independent studies, although rare, are valued in the literature.
Also, it was a well-designed study, running as a randomised controlled trial – the ‘gold standard’ for evaluating treatment effects.
Finally, it produced some surprising findings.
Even psychiatrists who are typically suspicious of drug-company claims that the newer drugs have ‘less side-effects’ (the evidence suggests they just tend to have different ones) will admit that the older generation of antipsychotic drugs produced permanent and unpleasant undesired consequences, including uncontrollable facial contortions and movement problems (something called tardive dyskinesia).
The presence of these might be thought to lead to a worse quality of life than the side-effect of the newer antipsychotics, which, although serious (typically an increased risk of diabetes, heart problems and obesity) can be at least partly dealt with by diet and exercise changes.
There’s a ongoing discussion at the British Medical Journal website, with lots of ‘damn the data, I know my experience’ type comments, but what this study suggests is perhaps that we need a better understanding of what people value in their lives, the impact of these drugs on how people live, and how to most appropriately measure life ‘quality’.
It’s also worth noting that these older drugs are now barely-profitable compared to the newer ones. The fact that independently funded studies tend not to produce as much supporting evidence for the most marketed medications suggests that a healthy skepticism about drug company marketing is a must.
UPDATE: Neuroshrink has added a fantastic commentary on this post, including some clarifications on things I missed and misinterpreted from this study. See the comments for more.
Link to study abstract.
Link to BMJ discussion.