Although the article “Avoiding EPS is key to realizing ‘atypical’ benefits,” by Drs. Rajiv Tandon and Robert J. Constantine (Current Psychiatry, November 2006), is more balanced than some reviews of the CATIE findings, it emphasized avoiding extrapyramidal symptoms (EPS) while ignoring two other features that are important when choosing an antipsychotic.
The first is the propensity for causing weight gain, hyperglycemia, and hyperlipidemia. The CATIE phase 1 investigation showed that second-generation antipsychotics (SGA)—especially olanzapine—are much more likely to cause these health-threatening complications compared with the first-generation antipsychotic (FGA) perphenazine.
The second consideration is cost. I am aware of economic arguments in favor of SGAs, especially if they prevent hospitalizations. However, in light of CATIE and the British CUtLASS 1 studies, it is unconscionable to not consider the huge difference in cost between SGAs and FGAs. Recent reports indicate that SGAs continue to outpace almost all other medications in price increases. This adds to society’s health-cost burden and creates a cruel inequity for those without prescription coverage.
It is an oversimplification of our clinical duty to refer to avoiding EPS as the “key” to antipsychotic treatment. We can only wish it were that simple.
Dennis Helmuth, MD, PhD
Clinical associate professor of psychiatry
Northeastern Ohio Universities College of Medicine,
Wooster, OH