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Anti Psychotic Effectiveness Rankings


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Two separate studies published in the April 2006 edition of American Journal of Psychiatry studied ranked the effectiveness of Anti Psychotic medicines [in treating schizophrenia] by patient preference and by length of use and obtained nearly identical results:

- Clozaril

- Zyprexa

- Risperdal

- Seroguel

- Geodon

In the first study [schizophrenic] patients were asked which drug the would choose if they had to switch from a hypothetical randomly assigned drug.

The second study looked at what drugs schizophrenic patients used and how long they remained on them.

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Somthing to keep in mind:

Effectiveness presupposes purpose.  Something can not be effective without being effective at or for somthing.

In this case the purpose is treatment resistant schizophrenia, not the reason the vast majority of people here are taking APs.

To think that a drug is best suited for use in, say, bipolar mania, simply because it is best suited for use in schizophrenia is just as erroneous as thinking that it would be best suited for use as a television antenna.

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So nice to see a study comparing effectiveness made public.

But it does need to be emphasized that these drugs have serious side effects and the side effects  profile needs to be considered in matching pt to med. Clozaril though it is indeed considered the gold standard in terms of treatment of say, chronic, disabled,  long term patients,  requires weekly blood tests to monitor for a fatal bood disorder. All can cause obesity, sexual dysfunction and over time (even the newer ones) TD, pseuroparkinsonism, and  diabetes.

Most distressing to me at his point, is that they have no handle at all on cognitive dysfunction secondary to the medications - and what do they jolly well expect when they pretty much block dopamine from the whole brain (even though it only seems implicated - and by no means exclusively -  in the mesolimbic cortex)? 

It appears to be the negative symptoms of sz that patients and families complain of the most (surprisingly to some, but not to me as the mother or a son with sz) .  What has mattered the most to the investigators is the chemical straightjacketing effect of AP meds - pts were dedated and not actively acting and talking crazy.    They didn't care that the pts were  listless and completely blunted emotionally! 

Thank God, now they're starting to care - and that's why the new meds in the pipeline are to address cognitive dysfunction. I'll bet/hope the day comes when modern APs and AAPs are considered  almost as inhumane and primitive as lobotomies and leucotomies.  (JFYI They're still performing psychosurgery for mental and emotional conditions).   

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You are completely incorrect on how the results were obtained. The investigator's personal desire to see patients chemically straightjacketed did not have any affect upon the results.

...Drug side effects and negative effects are always a concern with sz.  We had several posts to studies a couple weeks ago about researchers studying whether schizophrenia can be classed as different levels that might not require immediate medication.

A.M.

<{POST_SNAPBACK}>

AM,

I spoke without clarity.

My remark about "investigators" was a reference (admittedly wholly misleading in this context) to the history of psychiatric treatment and social priorities in seeking solutions for psychotic patients, specifically here those with schizophrenia.

(Prepare for long run-on sentence.  And A.M. this capsule history is not aimed at you as I'm quite sure you are familiar with all of it and more.  Just defensively trying to explain where I was coming  from for anyone who troubles to follow this thread, and is curious about what I WAS going on about). 

Beginning with theories of demonic possession treated with forms of exorcism, progressing (this word is used loosely)  to restraints and asylums where the insane were left pretty much to claw each other to death, to random experimentation with various chemical agents and extreme experiences  (near freezing u.a.) , to psychosurgery,  ECT and insulin shock, finally "investigators"  (see what I mean?) happened serendipitously upon the discovery  that an investigational antihistamine led to marked sedation of out-of-control patients with psychosis. That agent was Thorazine and so a new period of treatment options was born. 

This research focus was on control of what came to be called the "positive symptoms" of sz. - florid hallucinations, delusions and the appearance of craziness.  Most of all, control period.  Hence the metaphors of chemical straightjackets and chemical lobotomies as applied to the new APs. As one professor in Abnormal Psych remarked to us one day, "these disturbed [children] or more accurately, disturbing children...".  The medications were considered successful primarily when they met the social needs of making intractable patients, manageable (yes, much like lobotomies) and eliminating much of the scary symptomatology of "craziness" so troubling to the onlooker.  The out of reality experience.   

Furthermore

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Yeah. With depression and anxiety it's pretty much accepted that the whole point of treatment is about improving one's quality of life.  We'd like to think that such is the case with the treatment of psychotic disorders, but "quality of life" is subjective.  It's hard to say that many high dose APs leave one's quality of life vastly improved.  I spent 3 months on 10mgs a day of Zyprexa following a really bad LSD experience that didn't want to go away on its own.  Functional is not a word I'd use to describe my state during that time. 

I really want to see more of the methodology data, ie what the patients were actually asked when deciding what medication they preferred.  I'm willing to bet that what is used in the yahoo article and other PR writeups is a paraphrase.

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I spent 3 months on 10mgs a day of Zyprexa following a really bad LSD experience that didn't want to go away on its own.  Functional is not a word I'd use to describe my state during that time. 

<{POST_SNAPBACK}>

Curious. I've been on 10mg for the last three months after going nutso on TCAs (along with lamotrigine for BP2RC). I have been more functional and productive than at any time in probably the last 4-5 years.

Like they say, YMMV.

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  • 2 weeks later...

As a BP1 patient who has tried all these drugs + Abilify and not Clozaril, I rank them in the same order, with Cloz. being absent and Abilify being above Geodon. Geodon made me homocidal so I think I'm allergic. Thank goddess I got off of it ASAP.

I like Zyprexa but I gained 30lbs in about a month and had to switch, so I went to Risperdal and loved it. Until it made me lactate. Then I tried Abilify and really didn't like it. I went without an AAP for awhile, and am now starting a new, low dose (1mg=200mg Seroquel) of Risperdal. I hope no lactation is involved, but if it is, I accept it as a side effect.

-- loon--

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Too scared of the fatness that comes with Zyprexa, but I thought Risperdal did jack.  Just goes to show everyone is different.... Seroquel being the bomb, but nearly impossible to take the sedation side effect.

i think seroquel is great, other than the weight gain.

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I have tried almost every anti-psychotic (AP+AAPs) in the past 30 years(I was 16 when I first started the with the old APS). For me clozaril has been a life saver......literally! 

I am only on 200 mgs currently, but have been as high as 600, and was still able to function in a full-time job.  I never felt chemically straightjacketed!

I would much rather be able to do it without any meds.......but I know I can't:(. 

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You give me hope for my daughter.  It breaks my heart that such a talented and beautiful young lady has had to deal with this and will have to deal with it for the rest of her life.  She is finally coming to terms with it...it made me cry the other day because she quietly said "I'm going to have to take medication forever, aren't I". 

I'm glad you found a medication that works for you and that after 30 years you are living what sounds to be a productive life. 

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there may be a little selection bias with the clozapine vs olanzapine - here in australia at  least, you can't get clozapine without fortnightly review by a shrink. the patients i see on clozapine are managed in the community as far institutionalised as you can get as an outpatient. they get weekly, if not daily visits from a case worker, who arranges transport to and from their appointments, gets their meds for them, webster packs. etc. so they stay on it longer.

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