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Here’s a scenario for you. You have five medications to choose from. They are all FDA approved for the same indications. Any head-to-head study among them has shown equivalent efficacy. Three of them are associated with significant weight gain, hypercholesteremia, and diabetes risk. Two of them are not. Your job is to take a stand on what you would recommend as "first-line" medication for the disorder in question.

Clozapine (trade name, Clozaril) is a drug that none of us would prescribe if all things were equal. With the potentially catastrophic side effect of agranulocytosis, along with a metabolic side effect profile worse even than Zyprexa’s, the only reason to expose living beings to this medication is that it is reputed to be the most effective antipsychotic under the sun. But is it?

We knew it was about to happen. We just didn’t know it would happen all at once. Between July and September of 2004, Seroquel, Geodon, and Abilify sequentially won approval for the treatment of manic episodes in bipolar disorder.

Dr. Janicak, you've had a long career in research and academia, and I was hoping you could help shed some light on the various contentious issues surrounding the use of atypical antipsychotics, including the issue of whether there is clearly a difference in metabolic profile among the different medications.

We may think of clozapine as a drug of the ‘90s, but Sandoz began research on the drug in the early ‘60s, and the first paper appeared in 1966, the Medical Journal of Vienna.