Comparing Atypical Antipsychotics:
Schizophrenia, Bipolar Disorder, Depression, Dementia and Developmental Disorders
- Clozapine is superior to Olanzapine in preventing suicide attempts and worsening suicidal behavior in patients at high risk.
- Clozapine along with Olanzapine have lower rates of discontinuation of drug for any reason compared to other antipsychotics.
- Asenapine has higher rates of extrapyramidal side effects and more severe symptoms than olanzapine.
- Some studies also found risperidone and paliperidone had higher rates of extrapyramidal symptoms compared to olanzapine.
- Risperidone was found to result in more frequent or more severe sexual dysfunction symptoms than quetiapine, but was similar to extended-release paliperidone or ziprasidone.
- Among adolescents with schizophrenia, quetiapine was not superior to placebo based on response rate, but was superior based on improvements measured by the Positive and Negative Syndrome Scale.
- Women had greater improvements than men with clozapine and with olanzapine.
(B) Bipolar Disorder
- In manic or mixed episode, no significant differences were found between risperidone and olanzapine or asenapine and olanzapine for quality of life, response, or remission outcomes.
- Asenapine resulted in a higher risk of stopping the drug due to adverse events than olanzapine, but weight gain was greater with olanzapine.
- Weight gain was also greater with olanzapine compared to risperidone, but there were no differences in extrapyramidal symptoms or rates of discontinuations due to adverse events.
- In depressed episode, compared to placebo, only olanzapine and quetiapine (both immediate and extended-release) have evidence of significantly increasing the proportions of patients who achieve response and remission.
- In children and adolescents, compared to placebo, the following drugs have all been shown to increase the proportions of children and adolescents who achieve treatment response and remission: aripiprazole, olanzapine, immediate-release quetiapine, and risperidone. Overall however, the evidence is limited.
- The rate of treatment response was improved by the addition of aripiprazole, quetiapine (immediate and extended-release), and risperidone.
- Observational evidence suggests that use of antidepressants (SSRIs) plus olanzapine is associated with significantly greater weight gain than SSRIs plus either quetiapine or risperidone.
- The best evidence found similar rates of response and withdrawal, and no differences in clinical outcome measures for olanzapine, risperidone, and quetiapine.
(E) Developmental and Behavioral Disorders
- Compared with placebo, risperidone, aripiprazole, and olanzapine improve behavioral symptoms in children with pervasive developmental disorders such as autism.
- Risperidone and quetiapine showed efficacy in children and adolescents with disruptive behavior disorders such as conduct disorder.
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