Michael Thase, MD, on the Risks of Using Antipsychotics in Treating Depression
Now that the newer generation antipsychotics are becoming generic and less expensive, the first prohibitive factor, that they were just too costly to be used routinely, is dissipating. This is resolving and soon we'll have a range of different options for people, all falling into long generic pricing.
The real issue then becomes the safety and the longer-term worry with metabolic phenomena like weight gain and uncovering a liability to diabetes, developing dyslipidemia, elevated triglycerides, elevated cholesterol as examples.
There's ultimately the risk of tardive dyskinesia also. We know the metabolic risks are different for different members of the class, some have lower risk than others. We prefer to use those with lower risk of metabolic difficulties.
It appears that most of these drugs have the same low but not absent risk of tardive dyskinesia with longer term exposure, and that risk is less than one per hundred per year. It is a risk and the need to continue these treatments needs to be justified.
If you can't justify longer term treatment, you should consider tapering, evaluating the patient off the adjunctive medicine before deciding that the benefit outweighs the risk.