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THE NEW DRUGS
ARE THEY NO BETTER?
ARE THEY FOR YOU?
ARE YOU BEING
A View on
Atypical Antipsychotic Drugs
Provision of information about the new drugs used to treat schizophrenia, known as atypical antipsychotics, to those with the diagnosis has been patchy. The aim of this leaflet is to raise awareness of the new drugs by giving brief information about them and a view of their worth. The side- effects referred to are generalised and different drugs vary in the degree to which they cause particular side-effects. The generalisations are based on what has happened frequently with commonly used drugs.
Schizophrenia varies in degree and type and 25% of people getting the diagnosis only get one episode. But most get classified as moderate to severe and enduring and usually receive major drug treatment over many years. Some successfully come off drugs when the more florid aspects of the condition have burned out but this can take many years. For a great many medication turns out to be for life. For some, old drugs can feel worse than the illness and this has been a major reason for people to take themselves off them. This has frequently resulted in readmission to a mental hospital.
The new drugs can make life a lot more liveable for those taking them while satisfying the doctors that the symptoms of the illness are at least as well controlled as with the old drugs.
THE OLD DRUGS
Most of these drugs are notorious amongst many of those taking them for side-effects that can make them feel rotten. Very often they are what are called EPS symptoms. These include symptoms similar to Parkinsons Disease, a variety of other movement disorders and a sense of restlessness which can vie with a feeling of fatigue, making it very difficult to rest even though one wants to. Other unpleasant effects of these drugs can include impotence, depression, drowsiness and a dry mouth. These symptoms disappear if the drug is stopped and can be less on lower doses. In 20% of cases of long term use tardive dyskinesia, the serious and generally irreversible movement disorder develops, resulting from damage to nervous tissue in the brain. Increased mortality from heart failure has also been reported. The degree to which people get side-effects varies greatly as does the particular side-effects they get. A minority of patients prefer the older drugs to the new ones. The EPS side-effects occur to a significant degree in the majority of people taking most of these drugs.
THE NEW DRUGS
It has to be stressed that the new drugs are not better for everybody. They are the product of far more informed scientific research than preceded the introduction of the old ones. They found that the old drugs were suppressing parts of the brain that did not need to be and this accounted for some of the dehumanising side-effects - especially on high doses where people can become like shuffling old people and in great distress that does not show through a distant expressionless look.
The new drugs produce far less EPS symptoms. Some of them are unlikely to cause impotence. They will not reverse existing tardive dyskinesia but it is hoped they will not cause it at the rate the old drugs do. It is too early to know. They may produce side-effects like the old drugs but the ones that most trouble those who take them are usually less. Weight gain however can be greater on some of the new drugs. They are all significantly different compounds. You stand a good chance of finding one that is a great improvement for you on the old drugs but it may not be the first one you try.
Some health authorities were restricting the use of these new drugs on cost grounds. Since the original version of this leaflet was published NICE, the government body which decides which drugs are to be used by the NHS, approved the use of these drugs throughout the NHS. This stopped individual health authorities preventing their use in their areas.
Doctors however still have the final say in which drugs to prescribe and may still not be prescribing these drugs to save money or from a narrow view that eliminating "positive symptoms" (delusions, hallucinations and strange behaviour) is what treating the illness means and that many other aspects of the patient's well-being (including effectively creating another mental illness in place of the old one, which is more "manageable") are not important. Such a view is outrageous but may still be found amongst the most conservative and particularly older psychiatrists who have become set in their ways.
You should be wary if your doctor dismisses your request to try one of the new drugs by saying that they are no better than the old ones. The difference to you could be between being a true invalid and regaining some vitality and being able to enjoy life again.
SO WHAT SHOULD YOU DO?
If you are unhappy about taking the old drugs press your doctor to try you on one of the new ones and other new ones if the first one doesn't work out. If your doctor is obstinate see if you can get one who isn't. If you have continuing difficulties you can write to National Perceptions Forum about it and we will consider your letter/article for publication. A lot of people have felt great benefits from these new drugs. A lot of people haven't had the chance yet.
I do not doubt that these drugs are an important step forward. Don't accept just anything they give you.
Typical (old) Antipsychotics
Atypical (new) Antipsychotics
(Trade names in brackets)
BY CHRIS BARCHARD
National Perceptions Forum
15th Floor, 89 Albert Embankment, London, SE1 7TP.
(previously 28 Castle St, Kingston, Surrey)
First published 2001
This revision 2002