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Atypical antipsychotics have great benefits, serious side effects

Antipsychotic drugs represented an important advance in the treatment of mental illness. Before chlorpromazine (Thorazine) was introduced in the early 1950s, mental institutions often relied on padded cells, straitjackets or lobotomies to control unruly patients.

The medications, including haloperidol (Haldol), thioridazine (Mellaril) and trifluoperazine (Stelazine), seemed to help reduce hallucinations and calm agitation. But adverse reactions were common.

People taking such drugs became heavily sedated, slurring their speech and slowing their movements. Patients also complained of dizziness, constipation, urinary problems, sexual side effects, mental cloudiness and uncontrollable muscle twitches or spasms.

That’s why psychiatrists were excited when drug companies introduced a new generation of medications for schizophrenia starting about two decades ago. These “atypical antipsychotics” were expected to be much better tolerated. They included aripiprazole (Abilify), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal) and ziprasidone (Geodon). The hope was that these medications would allow people with mental illness to function normally in society without serious side effects.

In practice, however, the atypical antipsychotics were no more effective than older medicines for schizophrenia (New England Journal of Medicine, Sept. 22, 2005). Far from causing no adverse reactions, the atypical antidepressants can lead to Type 2 diabetes, rapid weight gain, seizures, headaches, blurred vision, cognitive impairment, irregular heart rhythms and stroke.

Despite their drawbacks, they are being prescribed for many conditions besides schizophrenia, including bipolar disorder, fibromyalgia, autism, ADHD and OCD. They’re also used as add-ons for depression. One reader wrote us about an experience with Abilify:

“I was prescribed Abilify as an antidepressant booster. The psychiatrist had put our entire therapy group on that drug.

“Abilify did not work for me and also caused alarmingly rapid weight gain, but the psychiatrist denied that the drug causes weight gain. He scoffed at the idea that Abilify was worsening my depression.

“I went to the Mayo Clinic for a second opinion and was told this drug often causes weight gain. The doctor took me off it immediately.

“My mood improved quickly, and the extra weight rapidly disappeared. I am alarmed to read that children vulnerable to peer taunting are given this drug. What are doctors thinking?”

Prescriptions for atypical antipsychotics have been increasing. Perhaps the substantial rise may be due in part to television commercials that present drugs like Abilify as solutions to antidepressant ineffectiveness.

Patients and their parents should be warned of possible worsening of depression or thoughts of suicide in children, adolescents and young adults. No one should ever stop Abilify or other atypical antipsychotics suddenly. There is a possibility of withdrawal symptoms, including sweating, nausea, vomiting, agitation, confusion, dizziness and uncontrollable muscle movement.

Despite the billions of dollars that have been spent on such drugs, they are not cures for mental illness. Many people benefit, but the pros and cons must be weighed carefully before such medications are prescribed.

Joe Graedon is a pharmacologist. Teresa Graedon holds a doctorate in medical anthropology and is a nutrition expert. Their syndicated radio show can be heard on public radio. In their column, Joe and Teresa Graedon answer letters from readers. Write to them via their Web site: