Supplement: The Lessons of CATIE

The Treatments

A Troubled History

First-Generation Antipsychotic Drugs

The Atypical Atypical?

The next generation?

Second-Generation Antipsychotic Drugs

Beyond Drugs

Nonmedication Therapies

When the results of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) were published in 2005, researchers presented clinicians with a surprise: Doctors had thought that second-generation, or atypical, antipsychotic medications were more effective, and produced fewer extrapyramidal side effects, such as tremors, rigidity, restlessness, and tardive dyskinesia, than their predecessors. However, the National Institute of Mental Health study found no significant difference between the generations in terms of efficacy, and only small differences in terms of side-effect profiles (NEJM, 353:1209-23, 2005).

For example, patients discontinued olanzapine, an atypical antipsychotic, and perphenazine, a typical antipsychotic, at the same rate due to intolerable side effects. For olanzapine, the reason was weight gain or metabolic effects, whereas for perphenazine it was extrapyramidal effects. "CATIE provided rigorous data that pulled the curtain ...