There are many antipsychotic drugs that have helped patients with schizophrenia. However, which antipsychotic medication is best? In April 2006 it was reported that Pharmaceutical giant Eli Lilly and Co. recently funded five studies that compared its antipsychotic drug Zyprexa with Risperdal, a competing drug made by Janssen. All five showed Zyprexa was superior in treating schizophrenia. But when Janssen sponsored its own studies comparing the two antipsychotic drugs, Risperdal came out ahead in two out of three. In fact, when a psychiatrist John Davis, analyzed every publicly available trial funded by the pharmaceutical industry pitting six new antipsychotic drugs against one another, nine in 10 showed that the best drug was the one made by the company funding the study.

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Antipsychotic drugs for schizophrenia
Schizophrenia is a severe psychiatric disorder in which patients experience distorted thinking, hallucinations and abnormal emotions. The disease is classified as a psychotic disorder, meaning that patients are often not completely in touch with reality. Therefore, the disease is treated with antipsychotic drugs, including the newer, "atypical" antipsychotic drugs clozapine and olanzapine as well as the older antipsychotic drug haloperidol.

Natural Options for those on Antipsychotic Drugs
Quercetin may be helpful in reversing some antipsychotic drug side effects.

Quercetin, a bioflavonoid, reverses haloperidol-induced catalepsy.
Methods Find Exp Clin Pharmacol. 2004 Jun;26(5):323-6.
Neuroleptics are extensively used in the treatment of schizophrenia and other affective disorders. Unfortunately their use is often associated with distressing side effects involving the extrapyramidal tract, such as Parkinsonism and tardive dyskinesia. Neuroleptic-induced catalepsy has long been used as a model for extrapyramidal side effects such as Parkinsonian-like bradykinesia associated with antipsychotic use in humans. In the present study, haloperidol was administered to mice to induce catalepsy. Pretreatment with quercetin dose-dependently reduced the catalepsy score in haloperidol-treated animals. The findings of the present study strongly suggest that quercetin can be screened as a potential drug candidate or as an adjuvant for the treatment of neuroleptic-induced extrapyramidal side effects.

Antipsychotic drugs and weight gain
The second generation antipsychotics clozapine and olanzapine frequently induce weight gain. Both clozapine and olanzapine can induce food craving and binge eating, however, olanzapine possibly to a greater extent.

Schizophrenia medication
Typical and atypical antipsychotic agents differ in their receptor-binding affinities, which are related to their differing side-effect profiles. Novel therapeutic strategies include normalisation of synaptic dopamine or serotonin levels, serotonin receptor antagonism and modulation of cerebral protein synthesis.
    A head-to-head comparison of five schizophrenia drugs found that most newer treatments are no better than an older generic drug, despite their higher cost. The lone exception, Eli Lilly and Co.'s Zyprexa, may be better than the other medicines but users experienced dramatic weight gain and developed a higher risk of diabetes. The drug is also the most expensive. The study used the amount of time patients stayed on a drug to help gauge its effectiveness. In all, 74 percent of the 1,432 volunteers at 57 study sites stopped taking the medication they were originally assigned. Only the schizophrenics taking Zyprexa, also known as olanzapine, stuck with it significantly longer than the other four. But even 64 percent stopped taking it after 18 months. The discontinuation rate was higher among the other four drugs: Seroquel (quetiapine) from AstraZeneca Plc; Risperdal (risperidone) from Janssen Pharmaceutical, a wholly owned unit of Johnson & Johnson; Geodon (ziprasidone) from Pfizer Inc., and perphenazine, which has been around since the 1950s and is available in generic form. One surprise was that perphenazine's side effects such as tremor, rigidity, stiff movements and muscle restlessness were not as common as expected. Patients tolerated it just as well as some of the newer drugs, and it was no less effective. And it was far cheaper. At the average doses used in the study, a month's supply of perphenazine capsules costs about $50 - compared with roughly $390 for Geodon, $425 for Risperdal, $475 for Seroquel, and $660 for Zyprexa.

     Atypical antipsychotics exhibit a reduced risk for tardive dyskinesia compared with conventional drugs. However, weight gain is more common with some atypical drugs (especially clozapine and olanzapine). Both conventional and atypical antipsychotics have been associated with diabetes, with most reports implicating both clozapine and olanzapine. Atypical antipsychotics (unlike conventional drugs) have little or no effect on QT and are not associated with sudden death.

Haldol antipsychotic
In 2007, Johnson & Johnson added new warnings to its antipsychotic drug, Haldol, about the potential risk of death and of dangerous heart conditions observed in some patients. High doses of Haldol can lead to QT prolongation, a disorder of the heart's electrical system that can lead to a life-threatening condition. Haldol drug is also sold generically under the name haloperidol.

Antipsychotic medication and blood sugar
Antipsychotic meds may raise blood sugar. High levels of sugar in the blood, also known as hyperglycemia, is a common finding in individuals taking atypical antipsychotics who originally had normal blood sugar levels.

Antipsychotics not helpful in Alzheimer's disease
Any possible benefits atypical antipsychotics may offer against psychosis, aggression, or agitation in patients with Alzheimer's disease are offset by the occurrence of side effects. Although atypical antipsychotics are widely used in patients with Alzheimer's disease, there is limited data regarding their safety and efficacy for this indication.
   "Alzheimer’s Drugs Offer No Help, Study Finds" was an article in the October 12 issue of New York Times written by Benedict Carey. According to this interesting article, the medicines most commonly prescribed for agitation and delusions in Alzheimer’s disease are no more effective than placebos, and put them at risk of serious side effects, including confusion, sleepiness and Parkinson’s disease-like symptoms. The drugs tested in the study — Zyprexa from Eli Lilly; Seroquel from AstraZeneca; and Risperdal from Janssen Pharmaceutical — belong to a class of medications known as atypical antipsychotics. These antipsychotic drugs are used to treat schizophrenia and other psychoses, and are commonly prescribed for elderly patients in long-term care facilities. About a third of the estimated 2.5 million Medicare beneficiaries in nursing homes in the United States have taken the medications.
   Antipsychotic medication to manage dementia-related behavioral or psychological symptoms is associated with increased risk of death.

Antipsychotic drugs not helpful for aggression
Two antipsychotic drugs -- haloperidol and risperidone -- long used to treat aggressive behavior in people with limited intelligence do not work and should not be prescribed for these patients. For the past several decades doctors have treated aggression in people who are not psychotic with these drugs, but placebos seem to do a better job.

Antipsychotic Drug Combination in Schizophrenia
Schizophrenics who take two antipsychotic drugs show no more improvement than those on a single drug, raising doubts about the benefit of using multiple medicines to treat the disease. A study, published in the New England Journal of Medicine, tested 68 patients who responded poorly to clozapine, the generic version of Novartis AG's Clozaril. Half the group took clozapine along with Johnson & Johnson's antipsychotic Risperdal. The other half were given clozapine with a placebo. Both groups showed the same degree of improvement during the 26-week trial, but there was a slight deterioration in memory among the ones taking Risperdal. The results offer no support for the idea of prescribing multiple drugs, at least from the same class, especially to people who got little help from clozapine.

Antipsychotic medication and metabolic syndrome

Treatment with clozapine, considered one of the most effective antipsychotic medication, appears to increase the risk of developing metabolic syndrome x. Metabolic syndrome is a cluster of conditions that includes obesity, high triglyceride levels, high blood pressure and high blood sugar levels. People with the syndrome are at increased risk for heart attacks and stroke. The findings stem from a study of 93 outpatients who were receiving clozapine as a treatment for schizophrenia or schizoaffective disorder. The rate of metabolic syndrome in this group was compared with that seen in 2701 control subjects matched by age, body weight for height, and race or ethnicity. Nearly 54 percent of clozapine -treated patients had metabolic syndrome compared with 20 percent of subjects in the comparison group. In addition to clozapine use, other risk factors for metabolic syndrome included older age and being overweight. American Journal of Psychiatry, July 2006.

Antipsychotic medication and weight gain
Early behavioral intervention prevents a significant amount of the weight gain associated with antipsychotic drug therapy. Up to 80 percent of patients taking antipsychotic drugs to treat schizophrenia and other mental conditions gain a significant amount of weight. To assess if drug-related weight gain can be attenuated, investigators used early behavioral intervention (EBI), designed to teach patients ways to maximize control over their weight, using nutrition, exercise and behavioral strategies. Dr. Mario Alvarez-Jimenez of the University Hospital Marques de Valdecilla in Santander, Spain, and others randomized 61 antipsychotic-naïve patients diagnosed with a psychiatric disorder to one of three treatments: risperidone (Risperdal), haloperidol (Haldol), or olanzapine (Zyprexa). Patients were then randomized to EBI or routine care. EBI was initiated at the same time as drug therapy, with the intention of preventing or minimizing weight gain. By the end of the study period, patients randomized to EBI gained a mean of 4.1 kg compared with a mean gain of 6.9 kg in the routine care patients, which was a significant difference. BMI -- the ratio of height to weight -- increased by 1.40 in the EBI group compared with 2.39 in patients who received routine, again a significant difference favoring EBI. A weight gain of more than 7 percent over baseline occurred in 39.3 percent of EBI patients compared with 78.8 percent in those receiving routine care. Journal of Clinical Psychiatry September 2006.

Antipsychotic drugs and fractures
Both conventional and atypical antipsychotics increase the risk of femoral fracture in institutionalized elderly most likely due to gait and movement disorders which increase the risk of falling.

Antipsychotic Medicine and Personality Disorder Treatment
The anti-psychotic drug Abilify (aripiprazole) appears to be effective for patients with borderline personality disorder, often leading to improvements in health-related quality of life and interpersonal problems. Personality disorder is a type of mental illness in which people have trouble functioning with others. It can be associated with depression and psychopathological symptoms. A few antipsychotic agents have been used in therapy for patients with borderline personality disorder. The most common side effects reported with Abilify were headache, insomnia, nausea, numbness, constipation and anxiety. American Journal of Psychiatry, May 2006.

Antipsychotic Drugs and Asperger's disease
The results of a study published in the Journal of Clinical Psychiatry suggest that symptoms of Asperger's disorder are improved by treatment with the atypical antipsychotic drug risperidone. Asperger's disorder has been described as a high-functioning form of autism. While patients with the disease have higher intellectual capacity than those with autism, they have a lower social capacity. The researchers enrolled 13 male patients between the ages of 6 and 18 years from March 13, 2002 to August 11, 2003. All of the patients were started on a standard dose of risperidone, which was increased to produce the maximum benefit with tolerable side effects. After 12 weeks, treatment with risperidone was associated with significant improvements in disease symptoms, the authors note. In addition, the severity of depression, a common feature of the disease, also improved with the drug. SOURCE: Journal of Clinical Psychiatry, December 2005.

Tourettes syndrome
The most frequently used drugs for tics arising from Tourette's syndrome are antipsychotics (mainly pimozide and haloperidol) and clonidine.

Antipsychotic medication and Heat Intolerance

Because antipsychotic medications can impair the body's heat regulation, patients receiving these medications should be cautioned against overexertion during hot and humid weather, and should be advised to seek cool environments and drink adequate amounts of fluids. Development of hyperthermia in individuals taking antipsychotic medication is potentially life-threatening, and requires immediate intervention and supportive measures.

Are Children Being Given too many Antipsychotics?
Soaring numbers of American children are being prescribed anti-psychotic drugs — in many cases, for attention deficit disorder or other behavioral problems for which these medications have not been proven to work. The annual number of children prescribed anti-psychotic drugs jumped fivefold between 1995 and 2002, to an estimated 2.5 million. But more than half of the prescriptions were for attention deficit adhd and other non-psychotic conditions. The increasing use of anti-psychotics since the mid-1990s corresponds with the introduction of costly and heavily marketed medications such as Zyprexa and Risperdal. The packaging information for both says their safety and effectiveness in children have not been established. Anti-psychotics are intended for use against schizophrenia and other psychotic illnesses. The drugs, which typically cost several dollars per pill, are considered safer than older anti-psychotics — at least in adults — but they still can have serious side effects, including weight gain, elevated cholesterol and diabetes.
     The prescription of antipsychotic medications for children and adolescents in the U.S. increased nearly 6-fold between 1993 and 2002. FDA has approved only three antipsychotic drugs — haloperidol, thioridazine hydrochloride and pimozide — for use in patients younger than 18 years, but most of the prescriptions written are for newer medications. Approximately 90 percent of antipsychotics prescribed are for the second-generation drugs — clozapine, risperidone, olanzapine, and quetiapine. None of these drugs is approved for treating adolescents or children. These drugs were prescribed primarily for disruptive behavior disorders, mood disorders, or pervasive developmental disorders or mental retardation. Only 14 percent were prescribed for psychotic disorders. Not enough is known about the metabolic effects of newer antipsychotics, particularly the long-term effects in young people.

Atypical Antipsychotic Mechanism of Action

Atypical antipsychotics have enhanced the treatment of schizophrenia. The mechanisms underlying the effectiveness and side effects of these drugs are not fully clear. When considering treatment models for schizophrenia, the role of dopamine receptor blockade and modulation remains dominant. The optimal occupancy of dopamine D(2) receptors seems to be crucial to balancing efficacy and adverse effects - transient D(2) receptor antagonism (such as that attained with, for example, quetiapine and clozapine) is sufficient to obtain an antipsychotic effect, while permanent D(2) receptor antagonism (as is caused by conventional antipsychotics) increases the risk of adverse effects such as extrapyramidal symptoms. Partial D(2) receptor agonism (induced by aripiprazole) offers the possibility of maintaining optimal blockade and function of D(2) receptors. Balancing presynaptic and postsynaptic D(2) receptor antagonism (e.g. induced by amisulpride) is another mechanism that can, through increased release of endogenous dopamine in the striatum, protect against excessive blockade of D(2) receptors. Serotonergic modulation is associated with a beneficial increase in striatal dopamine release. Effects on the negative and cognitive symptoms of schizophrenia relate to dopamine release in the prefrontal cortex; this can be modulated by combined D(2) and serotonin 5-HT(2A) receptor antagonism (e.g. by olanzapine and risperidone), partial D(2) receptor antagonism or the preferential blockade of inhibitory dopamine autoreceptors.
 

Antipsychotic Drug questions
Q. Can a person take saw palmetto or pygeum if on antipsychotic medication?
   A. Probably, as long as the dosages are low.

Q. Does choline interefere with antipsychotic medication?
   A. Perhaps since choline increases levels of acetycholine.

Q. Is there such thing as a natural antipsychotic? Im on haldol and am interested in investigating the possibility of a Natural antipsychotic.
   A. We are not aware at this time of a natural antipsychotic, although it is an interesting idea to research whether fish oils can help stabilize symptoms to a slight degree. This is just a guess at this time.
 

Atypical antipsychotic