Data on medicines for Huntington’s psychiatric symptoms lacking
Scientists reviewed 15 studies on the use of medications
Mental health problems are common in Huntington’s disease, but there isn’t much data on patients’ use of psychiatric medications, a review study reports.
“Although [neuropsychiatric problems] in [Huntington’s disease] are common, hardly any clinical trials have addressed their treatment,” the study’s researchers wrote. “As a result, evidence that would help formulating evidence-based clinical treatment guidelines is lacking.” The study, “Pharmacological Treatment of Neuropsychiatric Symptoms in Huntington’s Disease: A Systematic Review,” was published in Movement Disorders.
Problems among Huntington’s patients range from irritability and aggression to depression and apathy. There are no firm guidelines about how to manage these issues, however. A variety of medications, such as antidepressants, antipsychotics, and mood stabilizers may be used, but finding the right medicine often requires a lot of trial and error.
A lack of data
In the study, scientists in the Netherlands reviewed the scientific literature up to September 2024 and reported on the use of medications to manage psychiatric problems in Huntington’s.
“Optimal management of [neuropsychiatric problems] in [Huntington’s disease] is essential in reducing disease burden. Therefore, this review focuses on the available evidence on the effectiveness of pharmacological treatment of [neuropsychiatric problems] in [Huntington’s disease],” they wrote.
Fifteen studies were included in the final analysis: 10 appropriately controlled trials that tested a medicine against a placebo and five open-label studies wherein all the patients were given a therapy. Thirteen different medications were tested.
Collectively the studies included nearly 900 people with Huntington’s, though sample sizes varied substantially. Some studies had hundreds of patients, others less than 10. Some studies lasted roughly six months, others only about a month.
Measurements used to assess a medication’s effectiveness also varied. Some studies assessed the impact of treatment on scores related to a specific psychiatric issue like depression, whereas others evaluated how treatment affected global scores of psychiatric health.
Most of the placebo-controlled studies that assessed changes in neuropsychiatric composite scores found no effect of treatment. The only exception was one that tested nabilone, a drug that mimics the main psychoactive molecule of cannabis and that’s sold as Cesamet, among others, to help ease nausea and pain.
Some open-label studies reported significant improvements in overall psychiatric health with the antipsychotics cariprazine (sold as Vraylar, among others), olanzapine (sold as Zyprexa, among others), and risperidone (sold as Risperdal, among others). However, as these studies had no placebo group, it’s impossible to say if the improvements were due to the medication.
Data on the impact of medications on specific psychiatric issues were also sparse. For example, one placebo-controlled study using the antidepressant fluoxetine (sold as Prozac, among others) indicated the therapy tended to ease anxiety and depression, and significantly reduced irritability in patients.
An open-label study of olanzapine suggested the therapy eased depression, irritability, and suicidal thoughts. Data from open-label studies also showed that cariprazine and venlafaxine XR (sold as Effexor XR, with generics available) significantly lowered depression scores.
It’s difficult to draw firm conclusions on the basis of individual studies, however. No studies assessed the impact of medications on psychiatric issues like paranoia or hallucinations.
The researchers said there aren’t enough data to develop any solid evidence-based recommendations for what medications are or are not effective for mental health problems in Huntington’s patients. They said more studies are needed. “Better designed, larger, multicenter trials focusing on specific NPS are urgently needed to generate the knowledge to support the development of evidence-based clinical treatment guidelines,” they wrote.
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