Past Issues

Off-label Uses of Second-generation Antipsychotic Drugs

Chase R. Warren, Jonathan J. Serrato, Gerald A. Maguire

Pharmacotherapy in the area of psychiatry has continued to rapidly evolve as
we gain a greater understanding of psychopathology in various mental illnesses.
Since the advent of the second-generation antipsychotic (SGA) or atypical antipsychotic
drugs, they have largely replaced the use of its fi rst generation predecessors
in the treatment of schizophrenia. This change is primarily attributed to the
benefi t that SGAs do not carry as high a risk in causing detrimental extrapyramidal
adverse effects. These SGAs have not only proven to be effi cacious in the treatment
of schizophrenia, but their benefi t has also been investigated and some SGAs
recognized by the U.S. Food and Drug Administration (FDA) for use in the treatment
of bipolar disorder, autism, and major depressive disorder (MDD). The discovery
by scientists and clinicians of the versatility of SGA treatment in various
psychiatric disorders has prompted a call for further research in such disorders.
Many clinicians currently use SGAs in an off-label manner with the belief of suffi
cient evidence to suggest effi cacy and favorable tolerability. In addition to similar
SGA off-label use in bipolar disorder, autism, and major depressive disorder, the
greatest evidence for off-label use of SGAs currently lies in the treatment of Tourette’s
syndrome, posttraumatic stress disorder, attention defi cit hyperactivity
disorder-associated aggression, generalized anxiety disorder, stuttering, and potentially
obsessive-compulsive disorder. This overview provides clinicians with a
summary of current status of information in regards to the FDA-approved and
off-label uses of SGAs in conditions other than schizophrenia, bipolar disorder,
autism, and MDD.
Key Word second-generation antipsychotic drugs, atypical antipsychotic drugs, offlabel use, indications
Editorial Committe, Taiwanese Journal of Psychiatry
9F-3, 22, Song-Jiang Rd., Taipei 104, Taiwan
Email/ │ TEL/886-2-2567-8295 │ FAX/886-2-2567-8218