December 04, 2006

If the Drug Works Reasonably Well - Don't Switch

If a patient with schizophrenia has been doing reasonably well, long-term on a medication, switching to a different medication in an attempt to further improve outcome may backfire, so say researchers at Mount Sinai hospital in New York, a conclusion drawn from a large study Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) trial. Switching to a different antipsychotic medication when the one the patient is already on is working relatively well, often made matters worse rather than better.

The effects of switching medications early in treatment were not addressed in this study.

Suggestions coming from that study include:

  • Physicians should not be discouraged from trying new avenues in the event that the patient is a partial-responder (the medication helps alleviate some but not all symptoms).
  • Before switching a patient to a new drug, improving the current regimen through measures such as adjusting dosage and timing should be considered.
  • Patients should be made aware that all medications have the potential to cause their own distressing side-effects.

Read the Full Article: Switching Drugs No Panacea in Schizophrenia
Original Source: "Effectiveness of Switching Antipsychotic Medications." Essock SM et al. The American Journal of Psychiatry 2006; 163:2090-2095.

Read more about the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE):
CATIE II - Schizophrenia Treatment Study Update
Best Schizophrenia Drug? more CATIE 2 Study Results
The Significance of CATIE: An Expert Interview With Jeffrey A. Lieberman, MD
CATIE Study Helps Clinicians Tailor Schizophrenia Treatment
Older Medication May be More Cost-effective for Some People who Have Schizophrenia
Violence not an anomaly for some patients with schizophrenia


I personaly have'nt tried many medications. When I was first diagnosed I was put on Haldol and a coctail of meds in the hospital. When I got out my doctor suggested I try a new med on the market called Zyprexa. I've been on it ever since (10 years) at the same dose (10 mgs). Over the years my hallucinations have diminished to the point thier non exsistent. I have'nt heard voices for 2 years. I firmly belive that coctails and constently switching meds can slow recovery and be more harmful in the long run. For me it seems the longer I stick with my treatment as is the better I get.

Posted by: Josh Cunningham at December 4, 2006 02:54 PM

A number of years ago, I attended the NAMI conference in Nashville in order to understand my illness with schizophrenia better. Unfortunately, I heard the advice given in this piece "not to change antipsychotic" medicine unnecessarily. Several months later, I got caught in a heat wave, developed tardive dyskinesia and probably heat stroke that went undiagnosed. The losses snowballed -- memory, jobs, etc.,heightened "stigma" due to facial spasms, unresponsive doctors. Thanks to a gift from family, I was able to keep my housing and ten years later I have rebuilt my life. I assert there is very good reason to switch to an atypical neuroleptic.

Posted by: john at December 7, 2006 01:47 PM

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