Wednesday, September 09, 2009

Please Pass the Haldol

The atypical antipsychotics are getting a lot of attention lately: they cost a small fortune and they are associated with an increased risk for diabetes and cardiovascular disease. Oh, and they make people gain weight. All bad things.

The older neuroleptics worked fine, they treated psychosis. And with the financial and medicals burdens that come with the new medications, there is now some thought (at least by some people) that we should be re-visiting the old, cheap, and in-some-ways safer medications: Haldol, prolixin, navane, stelazine, trilafon: those guys.

I remember when that's all we had. The medications worked well for stopping the acute symptoms of psychosis. I don't prescribe them as a first line now, because back then, it seemed to me that people hated being on those medications. It was a hard sell to get someone to take prolixin, in a way that it isn't to get someone to try Seroquel. And people constantly stopped their own medications. There were some other problems with the older medications, as well: people had Parkinsonian side effects and looked like they were medicated, they gained weight and stopped menstruating . There was the risk of dystonia, irreversible tardive dyskinesia and fatal neuroleptic malignant syndrome. Someone once told me that being on Prolixin was like have molasses poured into your brain. And there were always the stories of medical students who tried the stuff.

So this post is a question to you:
If you're a psychiatrist: do you prescribe the older medications as a first line? Why or why not?
If you're a patient: if you've taken both, what do you think?
If you haven't taken haldol or any of it's brothers, would you be willing to try it? Why or why not?

Thanks in advance for your responses!