Schizophrenia Daily News Blog

Experts Debate Typical/Atypical Meds

Four schizophrenia experts squared off on the topic of first-generation antipsychotics (FGA, or "typical") versus second-generation antipsychotics (SGA, or "atypical") at the American Psychiatric Association annual convention in Atlanta, GA in May 2005.

The questions addressed included which class of drugs is superior in terms of efficacy and side effects, and whether comparison studies fairly represent clinically significant information.

Arguing on the side of FGAs were Rajiv Tandon, M.D., director of the schizophrenia division in the Department of Psychiatry at the University of Michigan, and William Carpenter, M.D., director of the Maryland Psychiatric Research Center. They were answered by John Davis, M.D., a professor of psychiatry at the University of Illinois, Chicago, and Ira Glick, M.D., a professor of psychiatry and behavioral science at Stanford University School of Medicine, who argued in favor of SGA superiority.

Main points in favor of SGAs included results from meta-analysis trials (Arch of Gen Psych, June 2003) showing greater efficacy of clozapine, amisulpride, risperidone, and olanzapine when compared with typical antipsychotic treatment. SGAs also seem to have more beneficial effects for negative and cognitive symptoms, which, the debators argued, improves long-term quality of life.

The FGA supporters took issue with the results of the meta-analysis. Biases in these sorts of studies, they contended, include significant between-group differences that are "averaged out" in the end with extremely large population sizes, recruited subjects who have already failed to respond to FGA, improper dosing of FGA in comparison to SGA (Carpenter claimed that studies using lower FGA doses showed better results), and the practice of including "last observation carried forward", meaning that patients who prematurely drop out of the study are still included, using the "last observed value of performance", in the final results in order to preserve sample size.

The four did agree on two points, both of which are important for doctors and mental health consumers alike: second-generation antipsychotics are not a homogenous class (and therefore are not freely interchangeable), and that the best treatments must be tailored to an individual's unique needs by the treating doctor. With this in mind, it is vital to keep both typical and atypical antipsychotics as an option for consumers to try.

To read the full story, please see: "Experts Square Off Across Antipsychotic Generation Gap", Psychiatric News (http://pn.psychiatryonline.org), July 1 2005.

More information on schizophrenia medications: http://www.schizophrenia.com/meds.html