Effectiveness of switching from antipsychotic polypharmacy to monotherapy

Susan M. Essock, Nina R. Schooler, T. Scott Stroup, Joseph P. McEvoy, Ingrid Rojas, Carlos Jackson, Nancy H. Covell, L. Adler, M. Byerly, S. Caroff, J. Csernansky, C. D'Souza, C. Jackson, T. Manschreck, J. McEvoy, A. Miller, H. Nasrallah, S. Olson, J. Patel, B. SaltzR. M. Steinbook, A. Tapp

Research output: Contribution to journalArticle

106 Citations (Scopus)

Abstract

Objective: This randomized trial addressed the risks and benefits of staying on antipsychotic polypharmacy or switching to monotherapy. Method: Adult outpatients with schizophrenia taking two antipsychotics (127 participants across 19 sites) were randomly assigned to stay on polypharmacy or switch to monotherapy by discontinuing one antipsychotic. The trial lasted 6 months, with a 6-month naturalistic follow-up. Kaplan-Meier and Cox regression analyses examined time to discontinuation of assigned antipsychotic treatment, and random regression models examined additional outcomes over time. Results: Patients assigned to switch to monotherapy had shorter times to allcause treatment discontinuation than those assigned to stay on polypharmacy. By month 6, 86% (N=48) of those assigned to stay on polypharmacy were still taking both medications, whereas 69% (N=40) of those assigned to switch to monotherapy were still taking the same medication. Most monotherapy discontinuations entailed returning to the original polypharmacy. The two groups did not differ with respect to psychiatric symptoms or hospitalizations. On average, the monotherapy group lost weight, whereas the polypharmacy group gained weight. Conclusions: Discontinuing one of two antipsychotics was followed by treatment discontinuation more often and more quickly than when both antipsychotics were continued. However, two-thirds of participants successfully switched, the groups did not differ with respect to symptom control, and switching to monotherapy resulted in weight loss. These results support the reasonableness of prescribing guidelines encouraging trials of antipsychotic monotherapy for individuals receiving antipsychotic polypharmacy, with the caveat that patients should be free to return to polypharmacy if an adequate trial on antipsychotic monotherapy proves unsatisfactory.

Original languageEnglish (US)
Pages (from-to)702-708
Number of pages7
JournalAmerican Journal of Psychiatry
Volume168
Issue number7
DOIs
StatePublished - Jul 2011

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Polypharmacy
Antipsychotic Agents
Weights and Measures
Psychiatry
Weight Loss
Schizophrenia
Hospitalization
Outpatients
Therapeutics
Regression Analysis
Guidelines

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Essock, S. M., Schooler, N. R., Stroup, T. S., McEvoy, J. P., Rojas, I., Jackson, C., ... Tapp, A. (2011). Effectiveness of switching from antipsychotic polypharmacy to monotherapy. American Journal of Psychiatry, 168(7), 702-708. https://doi.org/10.1176/appi.ajp.2011.10060908

Effectiveness of switching from antipsychotic polypharmacy to monotherapy. / Essock, Susan M.; Schooler, Nina R.; Stroup, T. Scott; McEvoy, Joseph P.; Rojas, Ingrid; Jackson, Carlos; Covell, Nancy H.; Adler, L.; Byerly, M.; Caroff, S.; Csernansky, J.; D'Souza, C.; Jackson, C.; Manschreck, T.; McEvoy, J.; Miller, A.; Nasrallah, H.; Olson, S.; Patel, J.; Saltz, B.; Steinbook, R. M.; Tapp, A.

In: American Journal of Psychiatry, Vol. 168, No. 7, 07.2011, p. 702-708.

Research output: Contribution to journalArticle

Essock, SM, Schooler, NR, Stroup, TS, McEvoy, JP, Rojas, I, Jackson, C, Covell, NH, Adler, L, Byerly, M, Caroff, S, Csernansky, J, D'Souza, C, Jackson, C, Manschreck, T, McEvoy, J, Miller, A, Nasrallah, H, Olson, S, Patel, J, Saltz, B, Steinbook, RM & Tapp, A 2011, 'Effectiveness of switching from antipsychotic polypharmacy to monotherapy', American Journal of Psychiatry, vol. 168, no. 7, pp. 702-708. https://doi.org/10.1176/appi.ajp.2011.10060908
Essock SM, Schooler NR, Stroup TS, McEvoy JP, Rojas I, Jackson C et al. Effectiveness of switching from antipsychotic polypharmacy to monotherapy. American Journal of Psychiatry. 2011 Jul;168(7):702-708. https://doi.org/10.1176/appi.ajp.2011.10060908
Essock, Susan M. ; Schooler, Nina R. ; Stroup, T. Scott ; McEvoy, Joseph P. ; Rojas, Ingrid ; Jackson, Carlos ; Covell, Nancy H. ; Adler, L. ; Byerly, M. ; Caroff, S. ; Csernansky, J. ; D'Souza, C. ; Jackson, C. ; Manschreck, T. ; McEvoy, J. ; Miller, A. ; Nasrallah, H. ; Olson, S. ; Patel, J. ; Saltz, B. ; Steinbook, R. M. ; Tapp, A. / Effectiveness of switching from antipsychotic polypharmacy to monotherapy. In: American Journal of Psychiatry. 2011 ; Vol. 168, No. 7. pp. 702-708.
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