Maintenance Medication for Schizophrenia: Strategies for Dose Reduction

Balancing the demonstrated effectiveness of antipsychotic medication for long-term maintenance treatment of schizophrenia with the risk of developing tardive dyskinesia (TD) has led to attempts to reduce dosage. Research using two methods is reviewed in this article; continuous low dose and intermittent or targeted medication. Both methods require monitoring of patients and treating decompensations with medication. Studies reviewed in this article indicate that these strategies are feasible for many patients, but are associated with higher risk of relapse than maintaining an established moderate dose. For low dose, relapse rates are higher if treatment continues for a second year, if dosage is very low, or if patients are not stable. However, low dose administration also leads to reduced adverse effects (including TD in at least one study) and improved subjective well being. Targeted medication leads to reduction of administered dose and side effects but to no clear benefit in terms of TD or social functioning. No studies reported to date have compared these strategies directly. Ongoing and future research will do this and identify those patients for whom these strategies can be implemented without increased relapse risk.