Anecdotally, adding an atypical antipsychotic to an antidepressant is a common practice for achieving a response in patients who have failed several medication trials. Do the data support this use of atypical antipsychotics?

In a 2005 public health advisory, the FDA warned that antipsychotics appear to increase the rate of mortality in elderly patients with dementia. The implication is that we should discontinue such agents in this population when possible. But does this actually decrease the mortality risk?

A recent meta-analysis examined all blinded clinical trials that directly compared second-generation antipsychotics, including 76 trials with 13,558 participants.

Over the past several years, the use of antipsychotics has expanded dramatically. Aside from the traditional indication, schizophrenia, various members of this class have received FDA approval for bipolar mania, bipolar depression, major depression, and autism, and increasingly they are used off-label for anxiety, insomnia, and agitation.

A recent NIMH-sponsored eight week trial compared two atypical antipsychotics, olanzapine (Zyprexa) and risperidone (Risperdal), to the first-generation antipsychotic, molindone (Moban) in the treatment of 116 youths with schizophrenia or schizoaffective disorder.

The FDA issued a Not Approvable letter regarding Vanda Pharmaceutical’s antipsychotic medication iloperidone (Fanapta). The agency based its decision on iloperidone’s question able efficacy results versus risperidone.

The first antipsychotic medication was discovered by a French naval surgeon named Henri Laborit. Dr. Laborit had little interest in psychiatry, but was avidly seeking a way to better treat wounded soldiers who were in shock.

You’ve probably heard about Fanapta (iloperidone), a new antipsychotic marketed by Vanda Pharmaceuticals. No, it hasn’t been approved officially yet, but it is likely to win approval in July, and the company has already been taking out teaser ads in the journals and has even sponsored a touring promotional CME program run by Stephen Stahl.

Here is some selective coverage of interesting recent developments in antipsychotic medications.

Dr. Jibson, there have been several meta-analyses comparing atypical antipsychotics published over the last few years. They are all long, complicated papers, and the conclusions are often controversial. Can you help us understand this literature?