March 02, 2007

Patients May Try Many Medications Before Finding One That Helps

The following is the first part of a press release issued by the National Institute of Mental Health (NIMH) that addresses a perplexing fact that patients and families coming to this site have often stated - that finding "the right" medication for them can be a frustrating ordeal.

This portion of the press release reports on second generation antipsychotic medications tried after a first-generation antipsychotic medication has failed. The outcome shows that patients may need to try multiple medications before finding one that is tolerable and effective for them.

New Details in Schizophrenia Treatment Trial Emerge Two new studies from the Clinical Antipsychotic Trials for Intervention Effectiveness (CATIE) provide more insights into comparing treatment options, and to what extent antipsychotic medications help people with schizophrenia learn social, interpersonal and community living skills. The new studies are published in the March 2007 issue of the American Journal of Psychiatry. CATIE, a $42.6 million, multi-site study, was funded by the National Institutes of Health's National Institute of Mental Health (NIMH).

Comparing Newer Antipsychotic Medications After Older One Fails

Quetiapine, and to some extent olanzapine, may be more effective than risperidone among patients who were originally taking, but had to discontinue, perphenazine—an older, first generation antipsychotic medication. However, patient responses varied considerably.

"CATIE continues to fine-tune our understanding of how our arsenal of antipsychotic medications work in real-world settings, but it also is revealing to us what questions we still must address," said NIMH Director Thomas R. Insel, M.D.

Of the 257 patients who were initially randomized to perphenazine in the CATIE study, 192 discontinued the medication for various reasons, including ineffectiveness and intolerable side effects. Among those who discontinued, 114 agreed to be re-randomized to one of three newer antipsychotic medications—olanzapine, quetiapine or risperidone.

T. Scott Stroup, M.D., MPH, of the University of North Carolina at Chapel Hill, and colleagues compared the effectiveness of the medications by determining how long patients stayed on their assigned medication. Those taking quetiapine stayed on the longest—averaging about ten months before discontinuing. Those taking olanzapine discontinued after an average of about seven months, and those taking risperidone discontinued after an average of four months.

Although the discontinuation results suggest that olanzapine was generally on par with quetiapine, patients taking olanzapine experienced more side effects. While none of those taking quetiapine discontinued use due to weight gain or metabolic side effects, 13 percent of those assigned to olanzapine discontinued it due to weight gain or metabolic problems, and 5 percent of those on risperidone did so.

"These results reinforce the fact that finding the most effective medication for each patient sometimes means trying multiple medications," said Dr. Stroup. "They remind us of the considerable variability in clinical circumstances and of our need to be responsive to an individual's needs and preferences."

Full Press Release: New Details in Schizophrenia Treatment Trial Emerge
Original Source: Stroup TS, et al. Effectiveness of Olanzapine, Quetiapine and Risperidone in Patients with Chronic Schizophrenia After Discontinuing Perphenazine: A CATIE Study. American Journal of Psychiatry 2007; 164:3.

Related Reading:
Tailored Treatment of Schizophrenia
If the Drug Works Reasonably Well - Don't Switch
Older Medication May be More Cost-effective for Some People who Have Schizophrenia


What do you do if client does not want to take any meds? PS-why are the discussion boards not working?

Posted by: iwanttohelp at March 3, 2007 12:18 AM

"Iwanttohelp" -

Another CATIE study that will soon be posted talks about the need for family therapy, and NAMI addresses the need for community interventions. However, these other therapies are used in conjunction with medications, and each individual's needs and severity of their illness varies.

There is a book on the subject of lack of insight - I am Not Sick - I Don't Need Help by Xavier Amador. We also have links to some audio & video discussions about this topic. You might want to search the News Blog Archive for "Amador" or "insight".

PS- The Discussion Boards are expected to be back online within a few hours.

Posted by: Jeanie at March 3, 2007 06:18 AM


Some people would rather go through the trials of medications with therapy, food supplements and whatever else works, and find what does work, rather than live in the nightmare of psychosis and possibly being on the streets, prison and/or dead.

It is always a balancing act of risk vs benefit. For some, like you, the risk of side-effects outweighs the potential benefit. For example - Many people have Tourette syndrome, but not everyone takes medications for it. For some, they feel they can live with the tics just fine - it does not interfere with their lives too much, and therefore the risks from medications outweigh the potential benefit of minimizing the symptoms. However, for some, the symptoms are so severe that they would rather take the medication risk. For some rare individuals, their symptoms of Tourette's are so severe that they are willing to have brain surgery - and they have been helped by that. It is always risk vs benefit.

A comment on the Discussion Boards. Many people prefer the groups, many the discussion boards, many live chats, and for many others, they prefer a combination. I personally like both discussion boards and a specific Group. They serve different purposes for me.

I do understand the dismay of many when these boards are down. We create contacts and friends. We miss each other and the support from people we get to know over the years. Also, so many people read and use these boards that the collective wisdom is awesome.

There is a place for both (and more!), and I thank you for sharing with us the particular Google Group that you are on.


Posted by: Jeanie at March 3, 2007 06:43 AM

I went through many years of my life searching for the right medication--or, to be exact--- the right combination of medications. It wasn't until 1999, when I had the opportunity to be in a clinical trial for ziprasidone, that my life started to change for the better. Several years later, ziprasidone was approved by the F.D.A. as Geodon. I worked to find the best dose for me, and also added very low doses of quetiapine(for sleep) and a 2mg dose of aripiprizole, since it is a dopamine agonist , a well as an antagonist. At present, this seems to be a very excellent combination for me to maintain a high quality of life with few side-effects and optimal functioning. The issue of quality of life is most important, and I must say
that medications alone do not hold all the answers. A wellness oriented lifestyle is a necessity for one to truly have quality of life. This is what I have found in my own experience, and I am grateful for it!

Posted by: meghan caughey at March 3, 2007 07:20 AM

Yes, I'd rather be dead or homeless then take antipsychotics. And one day that may end up true.

Posted by: Cory Schulz at March 3, 2007 12:25 PM

For many people, luckily, taking antipsychotics along with any supplements and other hormones they may need that are also out-of-whack (there is often an endocrine system involvement which can affect the entire body), make them feel a lot better - not worse. Not taking them is what is horrible for them. That is why it is always individually assessed and weighted.

I take a medication for arthritic pain. I seriously assessed the risk vs benefit ratio and had tried other options. Luckily, I take the medication with no side-effects and only benefit. I might be a "wimp" to take medications of varoius kinds at various points in my life, but I guess I am spoiled by the quality of my life.

There are people who take other medications in this same manner, and they are not overweight or zombies, but instead are living a more active, alert life that they feel is worth living.

And there are people, like yourself, who live a worthwhile, happier life without any medications.

Posted by: Jeanie at March 3, 2007 02:19 PM

Actually the reason I'm so upset over the current state of medications is that I'm not able to lead a happy or worthwhile life all by myself, and the drugs do nothing to help me. I feel stuck with a disease for which there is no cure or treatment, and so there is this deep feeling of helplessness. Not to mention the fact that I don't have any form of health insurance, friends, or real family. It's an endlessly frustrating situation that even if I could afford help, there is nothing that they have to offer me.

Posted by: CorySchulz at March 3, 2007 09:34 PM

Pists on discussion board when it was working removed for no reason,Posts on here removed for no reason.. I'm getting the message loud and clear.

Posted by: Tim at March 5, 2007 01:13 AM

I find it offensive that my posts were found offensive and were deleted. I did not state anything besides basic observation of the side effects that are common with these medications. You should find the little packet that comes with your prescription offensive, not what I have to say. I was just reiterating what is already common knowledge, except that I say it in a way that makes it harder to ignore.

Posted by: CorySchulz at March 6, 2007 11:15 PM

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