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Alzheimer's Patients on Atypical Antipsychotics Experience

Apr 17, 2009 | Parker Waichman LLP

Some newer, atypical, or second-generation, antipsychotic medications have been found to have two serious adverse reactions.  The drugs both lower so-called “good” cholesterol and cause weight gain in older Alzheimer patients.

HealthDay News reports that in a study of over 400 elderly patients, medications such as Zyprexa (olanzapine) and Seroquel (quetiapine) were both linked to “significant” weight gain, saying that those patients specifically taking Zyprexa “experienced increases in waist circumference and declines in HDL cholesterol,” as well.  The study also revealed that the weight gain correlated to the amount of time the patient was on the medication; the longer the patient was taking the drug, the more weight gained, said HealthDay News.

The findings from the Clinical Antipsychotic Trials of Intervention Effectiveness—Alzheimer's Disease (CATIE-AD) study, were funded by the U.S. National Institute of Mental Health (NIMH), said HealthDay News, and appear in the April 15 issue of the American Journal of Psychiatry.  "These findings are especially troubling, because antipsychotics are associated with a higher risk of death and cerebrovascular adverse events in patients with dementia. They're often used to minimize disruptive symptoms (such as psychosis or agitation), but patients should be monitored more closely," said lead investigator Dr. Lon S. Schneider, in an American Psychiatric Association news release, quoted HealthDay News.  The team noted that similar “metabolic side effects” have been seen in schizophrenia patients taking the newer antipsychotics, said HealthDay News.

The Mental Health Social Worker pointed out that the majority of information on how these drugs metabolically affect the body is on younger or middle-aged schizophrenic patients.  The CATIE-AD study compared Zyprexa, Seroquel, and Risperdal (risperidone) to a placebo in 421 Alzheimer patients, said the Mental Health Social Worker, and found that while the drugs do benefit some patients suffering hallucinations, delusions, and aggression, for example, the medications offered no increased efficacy over placebos when looking at side effects.  Weight gain was most apparent in the first three months, with Zyprexa and Seroquel most associated with the effect, said the Mental Health Social Worker.  Weight gain of up to 0.14 pounds weekly was realized and women gained more weight than men.

Earlier this year, the New England Journal of Medicine released a study that found that some atypical antipsychotics double the risk of heart failure and death, raising questions about claims that atypicals are safer than older generation antipsychotics.  Atypicals are used to treat schizophrenia and other mental problems, but are also widely used off-label to treat dementia and childhood hyperactivity.  Many experts and patient advocates have called for a halt to such practices.

Although Risperdal did not elicit the same adverse effects, questions linger about that drug’s safety and efficacy based on earlier problems.  A prominent Harvard psychiatrist promised positive results to Johnson & Johnson before the start of some clinical trials for Risperdal.  Based on a prior Wall Street Journal piece, the revelations regarding Dr. Joseph Biederman came to light in court documents from a lawsuit involving Risperdal and other atypicals in which Biederman is a witness, not a defendant.


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