While a formal evaluation of CATIE’s impact on clinical practice has yet to be completed, most experts agree that the trial did not prompt physicians to switch from prescribing second-generation antipsychotics to prescribing first-generation medications. However, several discussants reported that after the trial, many psychiatrists began for the first time to question the evidence base supporting the second-generation antipsychotics. Many recognized that they had been misled by a combination of their own optimism about newer treatments and the pharmaceutical industry’s active marketing of second-generation medications. According to one discussant, the trial made psychiatrists more open to returning to first-generation medications because it showed that conventional antipsychotics used at low doses were still effective and not associated with extrapyramidal symptoms. The extent to which this interpretation of the trial extended beyond academic psychiatrists into the community at large is unclear.
Although the relative prescribing of first-generation and atypical antipsychotics might not have changed following CATIE, the use of olanzapine might have decreased over time. Olanzapine is the most efficacious second-generation antipsychotic, but it is also associated with the highest incidence of metabolic complications, including weight gain.