Short time on antipsychotics may up heart disease (Reuters)

NEW YORK (Reuters Health) – Antipsychotic medications, which have raised red flags in the past, may increase the risk of heart disease in as little as a few months, a new study says.

Among the people taking these drugs are patients with schizophrenia, who tend to have shorter-than-average life spans. So the role of antipsychotics in heart disease needs to be addressed, said co-author Debra Foley, senior lecturer at the Center for Youth Mental Health at the University of Melbourne in Australia.

Researchers have already reported that newer antipsychotics are associated with an increased risk of diabetes. The Food and Drug Administration put out warnings on this danger in 2004.

According to the new study, published in the Archives of General Psychiatry, patients taking antipsychotics tended to gain weight after one month and had increases in their cholesterol levels after three to four months.

Obesity, high cholesterol, and diabetes all increase the risk of heart disease.

"This change in risk is evident early in the course of treatment, within several weeks of continuous use, but may continue to alter over several years," Foley told Reuters Health in an email. The "risk varies depending on the specific drug taken and how long it is taken for," she added.

About one in 100 adults in the U.S. has schizophrenia, according to the National Institute of Mental Health.

But antipsychotic drugs are also given to some patients with bipolar disorder, personality disorders, or anxiety, said Dr. Karen Graham, assistant professor of psychiatry at the University of North Carolina School of Medicine. She was not involved in the study.

The drugs in Foley's study included Janssen's Risperdal, and Lilly's Zyprexa, among others.

"Lilly is confident in the overall benefit-risk profile of Zyprexa," a company spokesman told Reuter's Health in an email.

Zyprexa has been prescribed for an estimated 28 million patients around the world, and a large amount of evidence shows the drug is safe for the uses for which it's been approved, Lilly said.

Foley and her team looked at 25 previous studies that had tracked risk factors for heart disease in patients taking older or newer antipsychotics. These included high blood pressure, cholesterol levels, and body weight.

They found that across all the studies, six to seven of every 10 people on antipsychotics were overweight after six months. Before taking the drugs, only about four of every 10 were overweight, the same as in the general population.

This is important because these are generally young and otherwise healthy people, Graham said.

Researchers don't know why these drugs can increase heart disease risk, but a recent study showed they can affect how the body manages cholesterol, Foley said.

Both patients and doctors should be aware of the increased heart disease risk, Foley said, and work together to minimize the patient's risk.

SOURCE: http://bit.ly/hba3GD Archives of General Psychiatry, online February 7, 2011.

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Elderly get fewer antipsychotics after FDA warning (Reuters)

NEW YORK (Reuters Health) – An official warning about newer antipsychotics in demented elderly people appears to have deterred some doctors from prescribing the drugs, a new U.S. study shows.

The so-called black box warning was issued by the Food and Drug Administration in 2005 after studies found elderly people on newer antipsychotics such as Janssen's Risperdal and AstraZeneca's Seroquel died sooner than those who didn't take the drugs.

"The black box warning is really the strongest warning that FDA has short of pulling the drug off the market," said Dr. Helen C. Kales, a psychiatrist at the University of Michigan in Ann Arbor, who worked on the study. "It looks like the warning did have its intended effect."

Some doctors use antipsychotics to control difficult behaviors in old people with dementia, although they haven't been specifically approved for the purpose.

More than one in ten Americans over 70 have dementia, and often that causes problems like frequent agitation, aggression, paranoia, and delusions.

"A lot of time and money are spent dealing with these things," Kales said.

Based on data in the national Veterans Affairs registries from more than 250,000 veterans, she and colleagues found the overall use of new and old antipsychotics in elderly patients with dementia dropped from nearly 18 percent in 1999 to 12 percent in 2007.

While doctors used the older drugs less and less over the entire period, the newer ones became increasingly popular until 2003, when early warnings began to circulate among healthcare providers.

Then in 2005, use of newer antipsychotics suddenly began dropping, too.

"We began to be aware that there was no free lunch," Kales told Reuters Health, noting that doctors had hoped initially that the newer medications -- also known as "atypical antipsychotic drugs" --would have fewer side effects than the older ones.

As it turned out, they replaced one set of side effects -- such as movement disorders -- with others, such as pronounced weight gain and diabetes.

Kales said antipsychotics might still have a place in treating some psychotic elderly patients, but they should be used cautiously.

For instance, simple things such as switching a male for a female caregiver might ease symptoms in some patients, whereas antidepressants may help others.

Kales also said she now discusses the risks and benefits of using antipsychotics with the family before putting a patient on the drug.

"The take-home message for me is we need to continue to look for better treatments, perhaps by studying behavioral interventions," Kales said. "There is still a group of patients out there who really need help."

SOURCE: http://bit.ly/iiwWKH Archives of General Psychiatry, online February 7, 2011.

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