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Antipsychotic drugs a last resort for
these 5 conditions Consumer-Report-Logo
Safety issues are a concern when used off-label to treat anxiety, ADHD, depression, insomnia, and PTSD, our analysis finds

Background

Advice and Recommendations from Consumer Reports Best Buy Drugs

The use of antipsychotic drugs to treat conditions not approved by the Food and Drug Administration has increased significantly in the last decade in children and adults. Conditions include anxiety, attention-deficit/hyperactivity disorder (ADHD), insomnia, post-traumatic stress disorder (PTSD), and some types of depression. (See Table 1 for list of drugs and their approved uses.)

This is known as “off-label” prescribing, which doctors can legally do. But in the case of these drugs, it’s a concern because our analysis shows that there is only limited research about the effectiveness and safety of antipsychotics drugs when used for these conditions, and that it’s unclear whether any potential benefit outweighs the risk of experiencing side effects.

Some of the possible side effects can be serious, and include: muscle rigidity, slow movement and involuntary tremors (known as extrapyramidal symptoms, some of which can be permanent), substantial weight gain, an increased risk of type 2 diabetes, and elevated cholesterol levels. Most people who start taking an antipsychotic medication will experience at least one side effect. Of those who do, up to 30 percent of people experience a serious or intolerable adverse effect, and stop taking the medicine within days, weeks, or a few months.

Because of the limited evidence for the eight antipsychotic medications evaluated and the complexities of treating the disorders, we have not chosen a Best Buy in this special analysis. Our medical advisers recommend that you discuss with your doctor first trying standard treatment options, including nondrug strategies if appropriate and medications that are FDA-approved for your condition. Carefully consider an antipsychotic drug only if those other options fail to improve your symptoms.

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Antipsychotic drugs are also commonly used off-label in long-term-care settings to control agitation, aggression, hallucinations, and other behavioral symptoms in elderly patients with Alzheimer’s disease or other forms of dementia. But in 2005, the medications were found to be associated with an increased risk of death among elderly people with dementia, primarily due to strokes. As a result, all antipsychotic drug labels now carry a black box warning—the strongest kind—about this risk.



See here for the full report on the off-label use of Antipsychotic drugs.



Table 1. Medications Evaluated in this Report

Generic name Brand name(s) Available as a generic? Conditions approved by FDA to treat
Aripiprazole  Abilify No ■ Major depression (as an add-on to other medications)
■ Bipolar disorder
■ Schizophrenia
■ Irritability associated with autism
Asenapine  Saphris No ■ Bipolar disorder
■ Schizophrenia
Iloperidone  Fanapt No ■ Schizophrenia
Olanzapine  Zyprexa,
Zyprexa Zydis
Yes ■ Bipolar disorder
■ Major depression (in combination with fluoxetine [Prozac])
■ Schizophrenia
Paliperidone  Invega No ■ Schizoaffective disorder
■ Schizophrenia
Quetiapine  Seroquel,
Seroquel XR
Yes ■ Major depression (as an add-on to other medications)
■ Bipolar disorder
■ Schizophrenia
Risperidone  Risperdal Yes ■ Bipolar disorder
■ Schizophrenia
■ Irritability associated with autism
Ziprasidone  Geodon Yes ■ Bipolar disorder
■ Schizophrenia




If you do decide to try an antipsychotic drug, carefully weigh the risks of the medication against the potential benefits, if any. Your doctor should monitor you for side effects. This includes assessing your weight, checking your muscles to make sure they are functioning well, and performing blood tests. If your symptoms don’t improve, you should stop taking the medication.

Cost might also be an important factor to take into account. Most of these antipsychotic drugs are expensive, so if you and your doctor decide that you should start taking one, find out how much of the price your insurance plan covers and how much you will have to pay out-of-pocket.

Another important issue to consider is that it is not clear from the available studies what dosage is correct for a person to take for the various off-label uses. We are unable to make any recommendation about how much a person should take, so you should discuss this with your physician. In some cases, a lower dose than is typically used to treat FDA-approved indications, such as schizophrenia, might be adequate for an off-label use.

For more about antipsychotic drugs, see these additional Best Buy Drugs reports.

Use of Antipsychotic Drugs in Children

Antipsychotic Drugs for Depression



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