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Intermittent drug techniques for schizophrenia

Sampson S, Mansour M, Maayan N, Soares-Weiser K, Adams CE
Published Online: 
23 July 2013

Antipsychotic medication is the main treatment for schizophrenia and helps people cope with positive symptoms such as hearing voices, seeing things and having strange beliefs. However, long-term exposure to these drugs has been associated with serious side effects, such as: weight gain; uncontrollable shaking of the head, body or hands; tremors; muscle stiffness; difficulties with walking and balance; sleepiness or apathy; and even death. Some people stop taking their medication as these side effects limit people’s quality of life. Not taking medication can be a contributory factor that leads to relapse and hospitalisation. Against this backdrop, there is cause to consider the role of intermittently administering antipsychotic medication compared to the continuous use of antipsychotic medication.

Intermittent drug techniques refer to the use of medication only during periods close to relapse of symptoms rather than continuously taking antipsychotic drugs all the time. Intermittent drug techniques include: prodrome-based intervention (which assesses the risk or early stage of relapse); crisis intervention during an acute episode or downturn in mental health; gradually increased drug-free periods; and drug holidays. The aim is to reduce exposure to drugs and decrease side effects.

This review assesses different intermittent drug techniques compared with maintenance treatment in people with schizophrenia or related disorders. Seventeen studies with 2252 participants compared intermittent drug techniques with standard maintenance on medication. Relapse was significantly higher in people receiving intermittent drug treatment. Hospitalisation was higher for people receiving intermittent drug treatment.

Results suggest that intermittent treatment is not as effective as continuous or maintained treatment in preventing relapse. Although information favours maintenance and continuous treatment, this is not always the case in real settings, where people may stop their medication due to debilitating side effects that affect their quality of life. More research is needed to assess any potential benefits or harm of intermittent treatment, particularly regarding the side effects commonly associated with maintained antipsychotic treatment. There was no exploration of economic/money savings, specifically relating to the potential cost-effectiveness of intermittent techniques.

Until further evidence is available concerning the potential benefits or harms of intermittent treatment, managers, psychiatrists and policy makers should consider it an experimental therapy.

This plain language summary has been written by a consumer Ben Gray, Service User and Service User Expert, Rethink Mental Illness.

This record should be cited as: 
Sampson S, Mansour M, Maayan N, Soares-Weiser K, Adams CE. Intermittent drug techniques for schizophrenia. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD006196. DOI: 10.1002/14651858.CD006196.pub2
Assessed as up to date: 
4 September 2012