Most Newer Antipsychotics No Better Than Older Ones, Just Different

Dec. 6 -- FRIDAY, Dec. 5 (HealthDay News) -- Antipsychotic drugs have traditionally been classified as "first" or "second" generation, but these classifications aren't valid and the drugs should be prescribed on a patient-by-patient basis, new research suggests.

Older drugs (first-generation) are cheaper than the newer "atypical" antipsychotic (second-generation) medications and have different side effects. But, the added cost of second-generation antipsychotics -- with an estimated $7.5 billion in U.S. sales in 2003 -- has led to debate about their benefits compared with first-generation drugs.

"In recent years there has been a number of new antipsychotic, and there had been controversy over which is the best," said study author Dr. John Davis, a research professor of psychiatry at the University of Illinois at Chicago.

"What we find is that different ones are better or worse in different ways," Davis said. "Therefore, the newer drugs can't be thought of as the same class. They each have their distinctive profile, with major differences between them."

The findings were published in the Dec. 5 online edition of The Lancet.

For the study, Davis and his colleagues reviewed 150 studies that included more than 21,000 patients. The researchers looked at overall effectiveness, side effects, depressive symptoms, relapse rates, quality of life, and weight gain, among other measures.

The analysis found four second-generation drugs, amisulpride (Solian), clozapine (Clozaril), olanzapine (Zyprexa) and risperidone (Risperdal) were more effective than first-generation drugs, with "small to medium effect sizes."

But, other second generation drugs, such as aripiprazole (Abilify), quetiapine (Seroquel), sertindole (Serdolect), ziprasidone (Geodon) and zotepine (Nipolept), were no more effective than first-generation drugs, the researchers reported.

And, only aripiprazole and ziprasidone among the second-generation drugs did not induce more weight gain than the first-generation drug haloperidol (Haldol), the study found.