Olanzapine should not be a first-line therapy in adolescents, Sikich said.
Both the older typical antipsychotics and newer atypical ones block dopamine receptors in the brain, but the newer drugs also interact with serotonin receptors and cause fewer muscle side effects, including stiffness, muscle cramps, restlessness and involuntary movements. With some older drugs, the involuntary movements can lead to permanent physical disabilities.
There were more reported cases of restlessness with molindone treatment than with either of the two newer treatments. Participants treated with molindone were also required to receive another drug, benztropine, to decrease muscle cramps and stiffness.
Brandon Constantineau, 18, of Wilmington, N.C., enrolled in the TEOSS study about four years ago. He was initially prescribed olanzapine but quickly began gaining weight, ultimately adding more than 45 pounds over 36 weeks. He was switched to molindone and gained about 8 pounds over the next 31 weeks and saw improvements similar to those with olanzapine. But, probably as a result of being on olanzapine, Sikich said, Brandon developed fatty liver disease and was ultimately prescribed two other medications.
Brandons case also highlights two other points Sikich makes in the study: the benefits of proper diagnosis and the need for more effective medications.
He was treated when he was very young, about 3, for ADHD, said Brandons father, Richard Constantineau. But medications and other therapies didnt help, and Brandon grew violent.
|Contact: Clinton Colmenares|
University of North Carolina School of Medicine