According to an article from the U.S. Department of Health and Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ), there is not enough evidence to support the use of atypical antipsychotic medicines for some treatments other than their officially approved purposes, despite that fact that several physicians still frequently prescribe these medications for so-called “off label” uses. An editorial based on data in the report is published in the Sep. 28 issue of the Journal of the American Medical Association.

The U.S. Food and Drug Administration (FDA) approved atypical antipsychotic drugs for treatment of schizophrenia, bipolar disorder and depression. However, the report discovered that often these drugs are prescribed for the treatment of other behavioral conditions.

Some evidence was discovered in the study (an update from a 2007 report) to support the off-label use of these drugs. The strongest evidence, for example, was for the off-label use of risperidone, olanzapine and aripiprazole for the treatment of dementia symptoms; quetiapine to treat generalized anxiety disorder,and risperidone to treat obsessive-compulsive disorder.

However, there was insufficient evidence to validate the use of these drugs or other atypical antipsychotic medications for the treatment of substance abuse problems, eating disorders or insomnia. According to the report, these drugs have been connected to some adverse effects, including a small increased risk of death in elderly individuals who suffer from dementia.

AHRQ Director Carolyn M. Clancy, M.D., explained:

“While atypical antipsychotic medications are not for everyone, many patients who suffer from psychiatric conditions have found these drugs to be very helpful. However, their off-label uses, while in some cases beneficial, is of concern because we just don’t know enough about their effectiveness and safety for multiple behavioral conditions. This report will give clinicians and patients additional information they can use to make the best possible decisions.”

Antipsychotic medications are usually divided into two classes, reflecting two waves of development: conventional (or ‘first generation’) and atypical (‘second generation’). At present the FDA has approved nine atypical antipsychotic medications: aripiprazole, asenapine, clozapine, iloperidone, olanzapine, paliperidone, quetiapine, risperidone and ziprasidone.

The authors warn that individuals should not make the assumption that all atypical antipsychotic drugs are similar, since they differ in effectiveness and adverse effects.

The report, “A comparative effectiveness review prepared for AHRQ’s Effective Health Care Program” by the Southern California Evidence-based Practice Center, based at the RAND Corporation, is available here.

The report, “Off-Label Use of Atypical Antipsychotics: An Update”, is the latest comparative effectiveness review from AHRQ’s Effective Health Care Program. The Effective Health Care Program assists patients, doctors, nurses, pharmacists and others select the most effective treatments by sponsoring the development of evidence reports and technology assessments to help both public- and private-sector organizations in their attempts to enhance the quality of health care in the U.S.. Further information about the program can also be found at the above link.

Written by Grace Rattue