New Results from CATIE project
NIMH just released the results from Phase II of their CATIE project. This is one of NIMH's mega intervention studies, this one with over 1400 people with psychosis. Here's a quote from the summary on their website:
"In phase 2 of this study, 543 people were studied in 57 different treatment sites to provide guidance to help doctors determine what to do next when patients need to change medications, a common occurrence in treating schizophrenia. Research has shown that patients who consistently receive treatment do much better than those who stop taking their medications, so finding the right treatment is crucial."
"Phase 2 of CATIE compared the medications, called "atypical antipsychotics," with each other in two different groups of participants. In one group, patients who had stopped taking a phase 1 medication because symptoms were not adequately relieved were randomly assigned to get one of four medications: clozapine, olanzapine, quetiapine, or risperidone. In that group, clozapine was the most effective. Forty-four percent of the patients who changed to clozapine stayed on it for the rest of the 18-month study, compared with 18 percent of patients who had changed to the other medications. On average, patients stayed on clozapine for 10 months, while patients on any of the other medications stayed on them for only 3 months.
However, not all patients can or want to take clozapine, because it may cause serious side effects in some people, including inflammation of the heart muscle, and agranulocytosis, which is a dangerous drop in levels of white blood cells that are part of the immune system. As a result, patients taking clozapine require close monitoring. Although the patients who took clozapine in this study tolerated it fairly well overall, one person developed agranulocytosis."
From: http://www.nimh.nih.gov/press/catie_phase2.cfm
Phase I results were really interesting with this surprising finding:
"Contrary to expectations, movement side effects (rigidity, stiff movements, tremor, and muscle restlessness) primarily associated with the older medications, were not seen more frequently with perphenazine (the drug used to represent the class of older medications) than with the newer drugs. The older medication was as well tolerated as the newer drugs and was equally effective as three of the newer medications. The advantages of olanzapine — in symptom reduction and duration of treatment — over the older medication were modest and must be weighed against the increased side effects of olanzapine.
Thus, taken as a whole, the newer medications have no substantial advantage over the older medication used in this study. An important issue still to be considered is individual differences in patient response to these drugs."
From: http://www.nimh.nih.gov/press/catie_release.cfm
Seems like many of the newer antipsychotics may be similar to the newer antidepressants, not much different than the older drugs, but with lots of hype and much bigger profits for the drug companies (Clozapine seems to be an exception for those who are treatment resistant). These newer drugs have been greatly hyped for their lower rates of movement side effects. However, most of those studies were drug company funded. This is a great example of why we need to have more studies that are not tied to drug company funding.
This is not to say that drug treatment can't be effective for many people, they can, rather the newer drugs, while very expensive, don't seem to add much benefit for most people.
Anyone care to comment?
- Jason Luoma's blog
- Login or register to post comments
Comments
Newer antipsychotics
Personally, I haven't seen too many people do really well on any newer anti-psychotic for a long period of time yet some people have done well for relatively long periods on the older ones. I think, with kids especially, they're starting medication way too early. (4, 5 yo sometimes) Even starting with teenagers, I don't know...About 2 years ago, there was an APA journal congratulating themselves in one article about getting atypicals out to younger kids because there wasn't the fear of side effects. Same journal, different article stated that, surprisingly enough, even though for many years, it was sort of accepted that about 33% of schizophrenics get better on their own, 33% go back and forth between hospitalizations, and 33% become chronic. Only 15% get better on their own now...I think we're over-medicating. Particularly with a young kid (15, 16, 17ish) who may have some psychotic features but many have enough ability left in their minds to "pull themselves out of the deep end of the pool." Give them some IM Haldol and Ativan and you take that ability away. Also, I know Clozaril has that reputation for working well in treatment resistant individuals but I've only seen it work like twice. (I do work with a really difficult population but still, it's been out, what, 15, 18 years? You'd think a few more would respond.)
As far as the antidepressants, I think there is so much placebo effect going on there. I've heard SO many people say, "Well, it worked for the first week or two but then it stopped working." Especially with antidepressants, people want a magic wand, a happy pill. With the commercials out on TV, it's hard to convince them that there is no magic wand.