CATIE study: What's It mean for Schizophrenics and Bipolars?

In recent post, I referred to the landmark CATIE study. I do not use the term landm ark lightly: This is the first study I know of that has tracked schizophrenics over a long time period (18 months vs. hte usual 4-8 week study that meds go through) and measured rates of discontinuation with atypicals as compared to an old, conventional antipsychtoic. The atypicals under study were Zyprexa, Seroquel, Risperdal and Geodon. The conventional antipsych was Trliafon, a med that was popular in the 1970s.

The atypicals have been used agressively in chronic schizophrenics since the late-1990s. In the last five years, they've also been used just as aggressively among bipolars. The CATIE study did not study their use among bipolars. In my mind, given that dosages of atypicals given to schizophrenics and bipolars are roughly equivalent, I believe that this study has implications for bipolars.

The total market for antipsychotics is $10 billion a year. About 90 percent of that comes from atypicals.

So what did the study reveal? That atypicals suck, basically. That they are far from the miracle drugs their makers have pimped them out as being. That schizophrenics stopped taking them because of their rotten side effects (weight gain being prime among those). That when the patients in the study were taking them, the atypicals proved to be about as powerful at treating schizophrenia as was the comparatively ancient Trilafon.

The rates of discontinuation for these meds were truly staggering--74 percent for the all of the meds taken together. The lowest rate of discontinuation was for Zyrexa (64 percent). The worst was Seroquel (82 percent). As the study stresses, patients were not just discontinuing meds because they felt like it, but in consultation with physicians directing the research.

I am not surprised by these results. I've interviewed several hundred people who've taken antipsychotics. The majority have reported going off the meds due to side effects such as weight gain (20 to 30 pounds a year) and what I've dubbed "heavy head," which is that lovely foggy mind you get from taking these meds--much as if you had downed a fifth of whiskey the night before.

What was equally unsurprising to me was that about 25 percent of patients taking the atypicals ceased treatment because the meds did little to addressing the underlying schizophrenia. It's a seldom discussed, but often whispered reality in psychiatry that meds don't perform very well for anywhere from 30 percent to 40 percent of patients.

Miracle drugs my ass.

I've already mentioned in another post that I believe this means that the Pharma companies have no choice but to cut their prices for these very expensive meds. I'll take that up again in a future post.

Note: After briefly being available for free on the New England Journal of Medicine's website, it now costs to access the study. I'll try to get a .pdf file of the study from someone within a few days and post the file or a link to it on this site. After all, this study was paid for with $42 million in taxpayer funds. Big Pharma didn't contribute a dime (ok, they contributed meds for the study). So I am at a loss as to why NEJM considers it proprietary.

Here's a link to the National Institute of Mental Health's press release on the study. Most news accounts of the study were so lame that I won't link to them.