Concomitant Medications May Not Improve Outcome of Antipsychotic Monotherapy for Stabilized Patients With Nonacute Schizophrenia.

Background: There are virtually no controlleddata suggesting that concomitant psychotropic medications (CPMs)improve outcome in schizophrenia after the acute phase. Despitethat, polypharmacy (with all of its disadvantages) is far morecommon than monotherapy. To our knowledge, there have been nopublished reports of prospective systematic investigations of theefficacy of unrestricted CPM use in nonacute schizophrenia.

Method: This was a naturalistic, systematicstudy using a sample of 53 stabilized patients with DSM-IV-TRschizophrenia from 1 clinical practice setting including bothprivate patients and patients from controlled research studies ofthe effectiveness of antipsychotics. Since there are meagercontrolled or systematic data on the effectiveness of CPM usewith antipsychotics in nonacute schizophrenia, we tested theclinical strategy of CPM use by gradually tapering all CPMs(except antianxiety agents). The aim was to determine if the CPMimproved outcome, had no effect, or worsened outcome using theClinical Global Impressions-Improvement scale before and aftertaper, over at least 3 months and in some cases up to 18 monthsafter discontinuation. Data were gathered from July 2002 to June2005.

Results: For 21 patients undergoing 22antidepressant tapers, no change was noted in 18 of 22 tapers,while in 3 improvement was noted and in 1 worsening was noted.For the 12 patients on treatment with mood stabilizers, no changewas noted in 10 of 13 discontinuations, while in 3 mild worseningwas noted. One patient was on treatment with both modafinil andtrazodone and reported no change after tapering each in separatediscontinuation trials, while another 3 patients were takingsleeping medications and also noted no change afterdiscontinuation.

Conclusion: For most stabilized, chronicpatients with schizophrenia, tapering adjunctive medications didnot change outcome. This naturalistic study further defines thelimits of efficacy of some concomitant classes of medications inpatients with chronic schizophrenia who are already receivingadequate antipsychotic therapy.