Q: Moban - a First Generation Antipsychotic
I am a 17 yr. old living with bipolar disorder. I have
been given many drugs none of which have made a significant improvement in my
illness. I have still not been put on the "big two" (Lithium and Depakote). I suffer from
PCOS so there has been a tendency to avoid drugs that induce weight gain. My
doctor has mentioned a very old typical antipsychotic called Moban. I can't seem
to find any literature on this medication. Do you know anything about it?
Dear Peggy --
In case you or other readers might need it, a little background: Moban is one of
the "first-generation antipsychotics."
Here are some typical first-generation antipsychotics:
For comparison, here are the second-generation
||smarmy trade name *
Antipsychotics generally have anti-manic properties.
Some second-generation antipsychotics have been demonstrated to prevent the
recurrence of episodes in Bipolar I (because their manufacturers spent the money
to conduct the research to get the FDA approval so that they can market their
drugs for this purpose. The lack of such evidence for the first-generation
antipsychotics is because of the lack of research of this kind for those
medications; from experience using them, it appears that they do indeed have the
capacity to prevent recurrent episodes, but that has not been tested directly).
The first-generation antipsychotics used to be part of
the standard treatment for bipolar disorder when lithium did not work -- because
we really didn't have anything else. Later, two anti-seizure medications were
recognized to have effects similar to lithium: Depakote (valproate) and
carbamazepine. I was not around for this period of research in psychiatry. I
only know of one direct comparison of these "mood stabilizers" (lithium,
Depakote, carbamazepine) versus a first generation antipsychotic. In that
study, Depakote worked as well as Haldol for psychotic mania. I think the
impression at that time was that antipsychotics were needed to treat psychotic
mania -- but I do not know if the mood stabilizers looked clearly better than
the first-generation antipsychotics in terms of overall bipolar disorder
control. That was just slightly before my time.
When I began practicing, the mood stabilizers were
already the established treatment for bipolar disorder, but I do not know if
that was based on solid evidence that they are better. They do not cause "tardive
dyskinesia", a concern with the first-generation antipsychotics. But, as you
know, most of the mood stabilizers have been associated with a risk of weight
gain. This can pose long-term health risks similar in magnitude to tardive
dyskinesia. Likewise, the second-generation antipsychotics are also commonly
associated with weight gain and thus with long-term risk, with the exception of
ziprasidone, which may be relatively weight-neutral. Aripiprazole is less likely
to cause weight gain than the other three.
Because these second-generation antipsychotics are
thought to cause tardive dyskinesia less frequently than they first-generation
antipsychotics, they are often considered nowadays for long-term treatment of
bipolar disorder. However, whether this difference in tardive dyskinesia arrest
is really all that large is still in doubt. Further, aripiprazole has a
different mechanism of action, so the extent to which it causes tardive
dyskinesia is even more unclear: it might be less than all the rest of them.
As for Moban in particular, I must admit: this is not
an antipsychotic I used at all. Among the first-generation antipsychotics, I
used the rest of the table above, but not that one. When we were using that
family extensively, there was a fairly strong impression that perphenazine might
be the best of the gang. For example, it was selected as the comparison
medication in a large test of the second-generation versus first-generation
I hope that something in that answer might be of use to
Published January, 2008