Adjunctive nefazodone in neuroleptic-treated schizophrenic patients with predominantly negative symptoms: an open prospective pilot study

A combination of nefazodone with a conventional neuroleptic would lead to a serotonin (5-HT)(2) and D-2 receptor blockade resembling that of an atypic al neuroleptic,,vith an additional increase of 5-HT (and noradrenaline) tur nover. This may be of benefit in some cases of schizophrenia. In this study , eight patients with schizophrenia with predominantly negative and/or depr essive symptoms underwent an open prospective 26-week trial with nefazodone , added to conventional neuroleptics. The total Positive and Negative Syndr ome Scale (PANSS) and the Montgomery-Asberg Depression Rating Scale (MADRS) scores (the last observations carried forward, LOCF) significantly (P < 0. 05) decreased in these eight patients by a mean of 31% and 63%, respectivel y, mainly within the first 6 weeks. Positive symptoms, observed in three pa tients and panic attacks in two patients disappeared entirely. The doses of neuroleptics, stable during the first 6 weeks of the trial, subsequently w ere able to be decreased by 28%. Extrapyramidal symptoms noticeably improve d during the phase of stable neuroleptic dose regimen. Of the three patient s who discontinued the trial prematurely (after 14 weeks or more), only one evidenced a nefazodone-related adverse event. Adjunctive nefazodone may be a useful treatment option in this patient population, but additional studi es are recommended. Int Clin Psychopharmacol 14:233-238 (C) 1999 Lippincott Williams & Wilkins.