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Medical Edge Newspaper Column from Mayo Clinic
SWITCHING TO NEW ANTIPSYCHOTIC DRUG MAY RELIEVE SYMPTOMS
DEAR MAYO CLINIC: I was diagnosed with schizophrenia nearly 20
years ago, and have taken haloperidol (Haldol) and trifluoperazine (Stelazine)
pretty much since then. Mentally, I’ve done very well — I have not been
hospitalized since 1992 — but the medications cause my mouth and tongue
to move uncontrollably. Can anything be done for these side effects? I
cannot afford a more expensive medication. — Seattle, Wash.
ANSWER: Your doctor should first refer you to a neurologist, who
may discover some other cause of these symptoms. But you most likely have
tardive dyskinesia — involuntary movements of the mouth, lips, tongue
and other parts of the body — a well-known side effect of long-term treatment
with the drugs that you have been taking.
These conventional antipsychotic drugs — which also include chlorpromazine
(Thorazine), fluphenazine (Prolixin), thiothixene (Navane), perphenazine
(Trilafon) and thioridazine (Mellaril) — have been used since the 1950s.
They’ve been very helpful to schizophrenia patients because they reduce
hallucinations (sensing things that don’t exist, such as imaginary voices)
and delusions (personal beliefs not based in reality). But they can have
unpleasant side effects.
In the last decade or so, a major new treatment for schizophrenia has
been the new-generation antipsychotic drugs such as aripiprazole (Abilify),
risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel) and
ziprasidone (Geodon). These medications are less likely to cause TD, and
they tend to alleviate the secondary symptoms of the schizophrenia — dulled
emotions, apathy and alterations in speech — that the conventional agents
don’t affect so well. The new-generation drugs may also relieve the TD
caused by previous conventional-drug therapy. But the new drugs have side
effects of their own, such as weight gain, other metabolic changes and
a propensity to develop diabetes.
Whether to use the conventional or new-generation drugs depends on the
particulars of the case, the specific side effects experienced and the
patient’s preferences. But given the likelihood that your TD symptoms
will worsen over time on the present regimen, it might make sense for
you to try to switch to one of the new-generation drugs, especially as
your positive history with Haldol and Stelazine suggests that you could
do well with them.
The most effective of these new antipsychotics is clozapine (trade name
Clozaril). Unfortunately, it has serious side effects that require close
monitoring of the white blood cell count to make sure that the immune
system is not compromised. Most other new-generation medications have
actually been developed in an attempt to replicate clozapine’s benefits
without its side effects, but scientists haven’t been able to accomplish
both goals.
Still, these medications often work quite nicely for many people. Current
treatment guidelines for recently diagnosed schizophrenia recommend that
patients first try one or more of the other new-generation drugs, and
later resort to clozapine only if necessary.
The new antipsychotics are very expensive, but they might not unduly burden
your budget. For one thing, people with major psychiatric illnesses, including
schizophrenia, are generally eligible for governmental assistance. Also,
numerous state, county and manufacturers’ programs exist to help patients
pay for the drugs. And individuals’ own health insurance plans may include
the new-generation antipsychotic drugs in their formularies and require
co-pays for them that are no higher than those of the conventional medications.
Your doctor may be able to recommend a social worker or case manager to
help you navigate these complex financial issues. The outcome for you,
financially and medically, could well be favorable.
— Timothy W. Lineberry, M.D., Psychiatry and Psychology, Mayo Clinic,
Rochester, Minn.
Additional Resources:
Treating Schizophrenia
Appointment
Information
More
Information on Schizophrenia
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Medical Edge from Mayo Clinic is an educational resource and doesn’t
replace regular medical care. To e-mail a question, go to www.mayoclinic.org,
or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite
114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2005 TRIBUNE MEDIA SERVICES, INC.
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