Potential Lower Efficacy of Molindone Among First-Generation Antipsychotics

To the Editor: In the November 2008 issue of the Journal, Linmarie Sikich, M.D., et al. (1) analyzed findings from the Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS) study. It was surprising to see that the authors selected molindone as the first-generation antipsychotic to compare with second-generation antipsychotics in the treatment of children and adolescents. Although treatment with molindone proved to be as efficacious as treatment with the second-generation antipsychotics assessed, other first-generation agents might have demonstrated superior efficacy. Unfortunately, clinical familiarity with first-generation antipsychotics (and with tricyclic antidepressants) is being lost to the detriment of some of our patients. As Baldessarini (2) warned, “molindone is not consistently as effective as other [first-generation] antipsychotic drugs” ( 2, p. 394). However, Sikich et al. noted in their study that molindone—among those patients for whom it is effective—does offer the distinct advantage of not causing weight gain.