Cross-sectional data suggest
link in patients with depression and schizophrenia
June 23, 2016 By Kristina Fiore
BERLIN -- Antipsychotics are tied to a higher risk of movement
disorders in both depressed and schizophrenic patients, researchers reported
here.
In a cross-sectional study, being on typical antipsychotics
carried an increased risk of movement disorders in both schizophrenic (OR 3.4,
95% CI 1.2 to 9.8) and depressive patients (OR 6.1, 95% CI 2.4 to 15.3),
according to Santiago
Perez-Lloret, MD, of the National Research Council in Buenos Aires,
and colleagues.
However, the risk was not increased among those on atypical
antipsychotics, they reported at the International Congress of
Parkinson's Disease and Movement Disorders here.
"We don't know why the risk was higher for depressed
patients compared with schizophrenic ones, but this is important because
clinical trials are not good for assessing the safety of drugs, and this is one
of the first postmarketing studies," Perez-Lloret told MedPage Today.
"It's important for physicians to be aware of the
possibility of these disorders and to have a close look when they give
antipsychotics to their patients," he added.
Ron Postuma, MD,
of McGill University in Montreal, who was not involved in the study, told MedPage
Today that the findings suggest that it "really does seem to be the
medications themselves driving the effect on movement disorders, rather than
the underlying condition."
Some studies have shown that antipsychotics are related to
movement disorders in schizophrenia patients, but it is hard to tease out cause
and effect, the researchers explained. The drugs have also been prescribed to
patients with depression, and it is not clear if the drugs are related to
movement disorders in this population as well.
Perez-Lloret and colleagues therefore looked
retrospectively at 814 patients with depressive disorders or
schizophrenia treated at several clinics in Central America. Overall, 25% of
the patients had schizophrenia, 33% had major depression, and 42% had bipolar
depression.
Overall, 7.5% of patients had movement disorders, which included
10.8% of those with schizophrenia and 6.4% of those with depression.
The most common movement disorder was tremor, at 5.9% of
schizophrenia patients and 3.6% of depressive patients, followed by akathisia
(3.4% and 1.5%, respectively) and tics (2.9% and 3.6%).
Factors associated with movement disorders included being male
(OR 2.21, 95% CI 1.26 to 3.88), being on typical antipsychotics (OR 4.49, 95%
CI 1.19 to 16.89), and being on lithium (OR 4.55, 95% CI 1.18 to 17.54).
Atypical antipsychotics and antidepressants were not associated
with movement disorders, the researchers noted.
Being on typical antipsychotics was associated with an increased
risk of movement disorders for both schizophrenia patients (OR 3.4, 95% CI 1.2
to 9.8) and depressive patients (OR 6.1, 95% CI 2.4 to 15.3).
That risk was significantly higher for depressive patients (OR
4.5, 95% CI 1.6 to 12.3), but Perez-Lloret said the reasons for this
association are not clear.
He added that both groups also reported worse quality of life if
they had a movement disorder.
When asked about potential mechanisms for the association,
Perez-Lloret said that the researchers "really don't know: These patients
have an alteration in dopaminergic pathways, which may by itself lead to
movement disorders, so there may be an interaction at that level."
He acknowledged that the cross-sectional nature of the study
makes it impossible to draw conclusions about those relationships, and noted
that other confounders could be at work, including the fact that some patients
who experience movement disorders may be switched to other drugs -- which could
account for the lack of an association between atypical antipsychotics and
movement disorders, he said.
"So we can't exclude the possibility that being on atypical
antipsychotics is also a risk factor for movement disorders."
http://www.medpagetoday.com/MeetingCoverage/MDS/58719?xid=nl_mpt_DHE_2016-06-24&eun=g972365d0r
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