A Reason To Make a Change?

Antipsychotic medications can be effective in treating psychotic symptoms among people with schizophrenia or related disorders. Unfortunately, some commonly used antipsychotics are associated with serious metabolic side effects such as weight gain and heightened cholesterol levels. These health complications can lead to heart disease or diabetes.

In some circumstances, it may be possible for people experiencing metabolic side effects to switch to a different antipsychotic.  However, doctors are often reluctant to make changes in patient’s drug regimen when the current medication appears to keep the person’s psychotic symptoms under control.  When considering a switch to a new antipsychotic, doctors must perform a careful balancing act, weighing the possible benefit of reduced metabolic side effects against the possible risk of symptom relapse or medication failure.

In an effort to address such concerns, a National Institute of Mental Health (NIMH) has published research designed to determine if an antipsychotic medication switch could be made safely and without sacrificing the clinical stability of the participants.

The study enrolled people who were taking a commonly used antipsychotic and were experiencing serious metabolic side effects.  Half of the participants were assigned to continue taking their current medication and half of them were switched to an antipsychotic that was associated with fewer metabolic risks.  All participants were put on a diet and exercise program designed to reduce the risk of cardiovascular disease.

After 6 months, the researchers found that those who had switched antipsychotics had improved cholesterol levels and had lost more weight, on average, than those who had stayed with their original medication. In addition, those who had switched medication did not experience any more illness relapses or worsening of psychotic symptoms than those who stayed on their original medication.

However, participants who changed to a new antipsychotic were more likely to stop taking their medication compared to those who continued to take their original medication.  Almost 44 percent of those who switched antipsychotics discontinued their new medication, as compared to the 24.5 percent of those who were assigned to stay on their current medication. The study’s authors suggest that since both the participants and clinicians knew which drug the participant was taking, patients who switched antipsychotics may have felt uncomfortable about the change.  Participants also may have been more likely to discontinue their medication when doctors noticed the first signs of difficulties.

Among persons with serious mental illnesses such as schizophrenia, schizoaffective disorder, and bipolar affective disorder, the metabolic side effects associated with second-generation antipsychotics may contribute to early deaths.  As a 2006 report by the National Association of State Mental Health Program Directors notes, persons with serious mental illnesses die an average of 25 years earlier than members of the general population and are at an elevated risk of dying from diabetes and heart disease.  In response to the health crisis affecting those with serious mental illness, Minnesota has launched a branch of the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) 10 by 10 Wellness Campaign.  This program seeks to increase the life expectancy of persons with serious mental illness by 10 years in 10 years through developing measures by which to track the health of persons with mental illnesses, raising awareness among consumers and mental health professionals, and by encouraging psychiatrists and primary care physicians to talk with patients about health risks and tools for health management.

To learn more about incorporating physical wellness in mental health recovery, please check out Steps to Wellness and Take Charge on the MHAM website.

This article was contributed by Claire Jamison, a volunteer for MHAM.