Steve is a 15 year old lad with an early-onset psychosis. He’s being managed at home by his family, with regular CPN visits from CAMHS.
He’s currently on 20mg Olanzapine each night, and seems to be just about coping. There’s a small amount of weight gain from the Olanzapine, but not to a worrying degree. His psychotic symptoms are still there, but the Olanzapine is reducing them to a point where he can usually ignore the voices. The local consultant decides to switch him to Aripiprazole. It’s the brand new wonder antipsychotic these days, apparently, and is supposed to be great for not sedating people or making them put on weight. The local rep tells us it’s ideal for young people.
So, Steve starts taking the Aripiprazole, and the doc begins reducing the Olanzapine. Within a week, the change in Steve is dramatic. He’s responding more and more to hallucinations. He’s increasingly thought-disordered. He’s anxious. He can’t sleep. His parents are at their wits end because Steve’s up until 2am terrified by the voices.
Okay, it’s a single anecdote, but it’s not just that this has happened to Steve. It’s not even that it’s happened to every patient I know who’s been switched to Aripiprazole. It’s more that every nurse I know has seen it happen to every patient they know who’s been prescribed Aripiprazole. Pretty piss-awful performance for a medication that costs £101 for a packet of 28.
Maybe we’ve just been really unlucky round our way?
