Q:  Any Thoughts on the New Antipsychotic Asenapine?

Dear Dr. Phelps,

My 15 year old bipolar daughter is in the process of a medication change. I was wondering if you have any thoughts on the new antipsychotic Saphris? I know it is quite new, but curious if you have an opinion about the drug yet. She is being weaned off Seroquel and it is being replaced with the Saphris. Also, she will be coming off her lamictal in two weeks. By the time done, she will be on only Saphris and lithium. Debating whether to wean her off of the lithium eventually also. She has been on same meds for quite a few years and they don't seem to be doing their job any longer. Have also tried antidepressants along the way, but they have made her worse!

I apologize...this is me being "brief". :)

Thank you for your time, and I enjoy your website!

Sincerely,
B

 

Dear Ms. B’--
First off, I’ve obviously not seen your daughter nor been involved in her care, so have no basis to speak here on what might be best for her. Some general thoughts, which may be yours as well, in which case perhaps I can support you by sharing them:

1. Unless things are really bad, I generally try to avoid making two medication changes at once. If only one medication changes, then it’s easier to say that whatever improvement (or worsening) that occurs is due to stopping or starting that one particular medication (because of course life is busy in the interim making its own changes, jobs or relationships or losses or other unfortunate events) so even with just one change, attributing causality is usually tricky.

On the other hand, trying to trim the medication list, stopping something to make room for something else, is a good idea lest the list get too long and contain too many medications that were never all that helpful.

But if things get worse now, is that from stopping lamotrigine, or quetiapine (Seroquel), or is it perhaps even caused by asenapine ? (Saphris; but let’s all try to call it asenapine from the start to foil the pharmaceutical marketing surge…)

Tricky choices, whether to change one or several things.

2. What about asenapine? No experience with it yet. I generally try to avoid using a new medication until I hear other prescribers raving about it (not patients, they only get one exposure to it, whereas prescribers get a look at numerous responses, not just one). If there’s no early positive raving, then I can wait until more data on its safety and its true actions (what do patients really get out of this) emerge from experience with thousands of patient exposures.

Like my dentist says about new tools: “I don’t like to be at the front of the pack, or the back of the pack; I like to be somewhere in the middle” in terms of when to start using them.

 I hope your daughter’s experience with these changes proves to be a positive one.

Dr. Phelps

 

 Published January, 2010