Raymond Cavanaugh, M.D., is a psychiatrist in private practice in Lawrence and Lynn, Massachusetts, and has an interesting take on the differences between the atypicals.
"I still prescribe Zyprexa more than anything else for my patients who are thoroughbred, true blue schizophrenics. I consider it to be a ‘junior Clozaril’ in that it's the best around for negative symptoms while being as good as Risperdal for positive symptoms. I watch these patients like a hawk for weight gain, I talk to them about not drinking sodas and I encourage exercise. I only check blood sugars in patients who are gaining weight despite these measures. But in reality, most of the patients I put on antipsychotics aren't schizophrenic, but have a kind of post-traumatic stress in which the trauma is ongoing, causing the original trauma to ulcerate. These patients suffer a kind of "cognitive fracture" with the original trauma and anxiety leaking out. For these patients, I usually use Abilify or Geodon, because the side effects are minimal, and these meds are great at cementing the fracture. Zyprexa may be better at doing a full repair and remediation, but these non-schizophrenic patients don't need that level of treatment."