Robert Freedman of the University of Colorado wrote in an accompanying editorial

The study of five commonly used drugs highlights how difficult schizophrenia is to treat. Three-quarters of patients had to switch medications because of breakthrough symptoms or intolerable side effects.

Those taking Eli Lilly & Co.’s Zyprexa did slightly better, staying on the medicine longer before switching and thus experiencing slightly fewer hospitalizations, researchers reported Monday.

However, Zyprexa was far more likely than leading competitors to cause some troubling side effects: severe weight gain associated with high cholesterol, high blood sugar and even Type 2 diabetes.

The big surprise was that older generic drug perphenazine was just as effective as Zyprexa’s main competitors — Seroquel, Risperdal and Geodon — and Zyprexa’s advantage was modest, the study found.

That is a striking finding, considering that the newer drugs cost more than 10 times as much as perphenazine, 온라인카지노 used since the 1950s.

And it led the National Institute of Mental Health, which funded the work, to declare there’s no clear winner. It said each drug has tradeoffs that must be considered for each patient.

«What works for one person may not work for another,» said Dr. Jeffrey Liberman, director of the New York State Psychiatric Institute and the study’s lead author.

The research is being published in this week’s New England Journal of Medicine.

Zyprexa remains a reasonable choice, but it should come with dietary and exercise counseling and be switched if excessive pounds threaten patients’ physical health, Dr. Robert Freedman of the University of Colorado wrote in an accompanying editorial.

«There is still a double-edged sword here,» agreed Dr. Leslie Citrome, a New York University psychiatrist not involved in the study. He said doctors had begun shying away from Zyprexa because of recent bad publicity about the weight gain.

«It’s important for clinicians to really keep an open mind and have everything available to them,» Citrome said. But the study starkly illustrates that «we really need treatments that will work better,» he added.

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