Reducing the Burden of Side Effects During Long-Term Antipsychotic Therapy: The Role of "Switching" Medications

One of the great challenges of long-term treatment of schizophrenia and related disorders is minimizing the medical or psychological burden from persistent side effects. Because of the differences in side effect profiles between the newer and older antipsychotic medications, and distinct differences among the newer agents themselves, the spectrum of side effects associated with antipsychotic therapy has changed tremendously. The authors review changing from one antipsychotic to another (“switching”) as a potential treatment strategy for reducing the overall side effect burden of antipsychotic therapy. This review identifies 6 steps to the evaluation of switching antipsychotics because of side effects: (1) Establish a causal attribution that the clinical problem is an adverse effect of the antipsychotic medication; (2) Understand the course of the side effect, especially regarding present and future risks for the individual patient receiving the antipsychotic treatment; (3) Understand the potential risks and benefits of other side effect interventions that do not require switching the antipsychotic; (4) Be aware of the side effect profiles of other possible antipsychotics, with an understanding of the potential effectiveness of changing (switching) to another antipsychotic for this side effect; (5) Calculate the side effect risks of switching antipsychotics; (6) Calculate the efficacy risks of switching antipsychotics. The authors explain how to evaluate the specific side effect in the context of the current medication and the overall management of the patient.