Schizophrenia drugs compared

WASHINGTON – The nation’s leading schizophrenia drug doesn’t work much better than an older, far cheaper medicine, says a major government study that found no clear winner in comparing treatments for the devastating mental illness.

The biggest surprise: An overlooked generic drug called perphenazine – around since the 1950s but seldom used – proved as effective as all but one of a class of newer treatments called atypical antipsychotics that make up 90 percent of schizophrenia-related prescriptions today. That one, Eli Lilly & Co.’s Zyprexa, worked slightly better but with a drawback: It was far more likely than leading competitors to cause severe weight gain, leading to high cholesterol, high blood sugar, even diabetes.

The findings are striking considering that perphenazine can cost no more than $50 a month compared with more than $600 for Zyprexa, depending on dose. The nation will spend about $10 billion this year on those atypical antipsychotics, said Dr. Thomas Insel, director of the National Institute of Mental Health, which financed the research.

A troubling finding: Three-quarters of patients switched medications because of inadequate symptom control or intolerable side effects.

“Make no mistake, these treatments are effective and far better than no treatment at all,” lead investigator Dr. Jeffrey Lieberman, of Columbia University and director of the New York State Psychiatric Institute, said Monday. But “when it comes to the treatment of patients with chronic schizophrenia, the glass is only half-full.”

“There may not be a magic bullet for schizophrenia,” Insel said. “We may need to find ways of combining treatments to get the maximal impact,” just as multiple drugs are used for other disorders, such as high blood pressure.

Publication of the sobering first results in this week’s New England Journal of Medicine may help doctors tease apart the trade-offs in picking which medicine to try for the 3.2 million Americans with schizophrenia.

Before the development of antipsychotics 50 years ago, most patients with schizophrenia – characterized by hallucinations and disordered thinking – were institutionalized. While the drugs have improved patients’ care greatly, they aren’t a cure, and side effects can affect how likely someone is to continue treatment.

First-generation drugs’ chief concern was Parkinson’s disease-like movement problems: tremors, rigidity, involuntary flailing. Zyprexa and its newer cousins rapidly gained popularity by promising an end to those problems, but they have their own side effects.