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Antipsychotics, first generation drugs as effective as newer ones in some children

Nearly every child who receives an antipsychotic drug is first prescribed one of the second-generation, or atypical drugs, such as Olanzapine ( Zyprexa ) and Risperidone ( Risperdal ). However, there has never been evidence that these drugs are more effective than the older, first-generation medications.

Now a study from the University of North Carolina at Chapel Hill School of Medicine suggests that Molindone ( Moban ), a first-generation drug, is as effective as the newer ones and should be used as a first line of therapy in some children with schizophrenia or schizoaffective disorder.

According to Lin Sikich, at UNC ( University of North Carolina ) people thought the second-generation drugs were superior because they had no side effects. Researchers found that Molindone works as well as newer drugs, and in some cases it’s safer.

The study is the largest head-to-head trial comparing the newer drugs, which became available in the 1990s, to the older ones, which have been around since the 1950s.

Between 2002 and 2006 the study randomly assigned 119 people aged 8 to 19 years to receive Molindone, Olanzapine or Risperidone over an eight-week period.

A decline in symptoms was similar across the three medications. But the drugs caused very different types of side effects. Both Olanzapine and Risperidone were associated with significant weight gain and could put young patients at risk of developing heart disease and diabetes. In fact, the National Institute of Mental Health, which sponsored the study, halted recruitment into the Olanzapine arm of the study because of the weight gain problem and the resulting increase in cholesterol and glucose levels.

According to Sikich, Olanzapine should not be a first-line therapy in adolescents.

Both the older typical antipsychotics and newer atypical ones block dopamine receptors in the brain, but the newer drugs also interact with serotonin receptors and cause fewer muscle side effects, including stiffness, muscle cramps, restlessness and involuntary movements. With some older drugs, the involuntary movements can lead to permanent physical disabilities.

There were more reported cases of restlessness with Molindone treatment than with either of the two newer treatments. Participants treated with Molindone were also required to receive another drug, Benzatropine, to decrease muscle cramps and stiffness.

Source: University of North Carolina School of Medicine, 2008