Side-Effects of Antipsychotic Medications

cont. from

Sedation: All the atypicals but Risperdal are horse tranquilizers, often merely in the initial phase of treatment before the body has a chance to adjust, but severe enough to be worrying, especially in these days of hit and run psychiatry where patients are sent out onto the streets disoriented and confused after maybe one or two nights in the hospital. Psychiatrists see Seroquel's sedating effects as an asset, however, often prescribing it (sometimes on an "as needed" basis) for sleep.

Sexual dysfunction: Approximately half of men and women taking antipsychotics complain of sexual dysfunction. Risperdal appears responsible for the most erectile failures while Clozaril appears to least troublesome. Risperdal and the older antipsychotics are responsible for raised prolactin levels, which can result in loss of sexual function and related effects in both men and women (more on this under Risperdal below).

Weight gain: A 1999 study by Allison et al found that Clozaril resulted in a mean weight gain of 9.8 pounds in ten weeks, 9.1 for Zyprexa, 6.4 for Risperdal, and negligible for Geodon. Seroquel wasn’t evaluated and Abilify was unavailable at the time. A 1997 study by Nemeroff found patients on Zyprexa gained 27 pounds over one year. Other one-year studies found weight gain leveled off in the single figures for Risperdal and Seroquel and was negligible for Geodon and Abilify. Product labeling shows nearly 30 percent of Zyprexa users added seven percent or more weight. Twenty percent of Seroquel users, more than 15 percent of Risperdal users, around 10 percent of Geodon users, and less than 10 percent of Abilify users crossed this "clinically significant" threshold.

Current Psychiatry reports that the good news is much of that weight can come off: One study found behavioral intervention helped patients who had gained more than 20 pounds to lose at least 10. Another study found Zyprexa users benefited from Weight Watchers.

With Zyprexa, weight gain reportedly plateaus after about 39 weeks, with the most rapid gain in the first 12, indicating the benefits of early intervention. One small study found Zyprexa patients who received education prior to treatment gained one pound in four weeks compared to 6.4 for the standard care group. (Now if doctors would only warn their patients when they prescribe these meds.) Axid (nizatidine), Topamax, and Symmetrel (amantadine) are known weight reducers when taken with antipsychotics.

Diabetes: With weight gain comes the risk of diabetes. According to an April 2003 Wall Street Journal front page article in on Zyprexa:

"Of the millions of patients who took the drug over an eight-year period that ended in 2002, 288 are reported to have developed diabetes. Seventy-five of those people became severely ill, and 23 died."

Those figures were taken from studies by Elizabeth Koller MD, a former FDA official, and P Murali Doraiswamy MD of Duke, first published in the July 2002 Pharmacotherapy, which in turn were based on voluntary reports to the FDA, which experts believe represent from one to 10 percent of actual cases.

Koller and Doraiswamy also fingered Risperdal, which was found to be linked to 132 diabetes cases, 31 life-threatening, and five ending in death over a nine-year period. Earlier, Dr Koller found a diabetes risk in Clozaril - 384 cases, 55 serious, 25 fatal - which has carried warnings since 1997. At the 2003 APA meeting, the two authors implicated Seroquel, involving 34 patients with newly-diagnosed hyperglycemia. There were 21 cases of diabetic ketoacidosis resulting in 11 deaths.

In 2003, a joint panel of the American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, and the North American Association for the Study of Obesity issued a consensus statement advising that patients taking atypical antipsychotics may be at increased risk for obesity, diabetes, high cholesterol, and heart disease. The panel recommended that doctors screen and monitor their patients on atypical antipsychotics for: 1) personal and family history of obesity diabetes, high cholesterol, hypertension, or cardiovascular disease; 2) weight and height; 3) waist circumference; 4) blood pressure; 5) fasting blood glucose; 6) fasting blood cholesterol.

The panel also advised doctors to refer their patients to specialists, if necessary.

"Antipsychotics should be monitored regularly for worsening of glucose control. Patients with risk factors for diabetes mellitus (e.g., obesity, family history of diabetes) who are starting treatment with atypical antipsychotics should undergo fasting blood glucose testing at the beginning of treatment and periodically during treatment. Any patient treated with atypical antipsychotics should be monitored for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia,and weakness."

next: Surprise! Are Newer Antipsychotics Better Than Older Ones?

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Reviewed: 03/2006