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Updated 20 August 2010
Printable version

Forum Discussion: Antipsychotic Dosing: How Much, But Also How Often?

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In our Forum discussion “journal club” series, the editors of Schizophrenia Bulletin provide access to the full text of a recent article. A short introduction by a journal editor gets us started, and then it's up to our readers to share their ideas and insights, questions, and reactions to the selected paper. So read on….

Send in your comments now! The paper under discussion:
Remington G, Kapur S. Antipsychotic Dosing: How Much but also How Often? Schizophr Bull. 2010 Sep 1;36(5):900-3. Abstract

View Comments By:
Donald Goff — Posted 20 September 2010
Herbert Meltzer — Posted 21 September 2010
Christoph U. Correll — Posted 22 September 2010
Giorgio Marchese, Luca Pani — Posted 22 September 2010
Gloria Reeves — Posted 24 September 2010
Bryan Roth — Posted 27 September 2010
Ripu Jindal, Matcheri S. Keshavan — Posted 27 September 2010
David Mamo — Posted 27 September 2010
Srihari Gopal, David W. Hough, Keith Karcher, Justine Kent, Andreas Schreiner, Larry Alphs, Joseph Palumbo — Posted 27 September 2010
John Kane — Posted 29 September 2010
Jeffrey Lieberman — Posted 28 October 2010
Gary Remington, Shitij Kapur — Posted 24 November 2010
Kenneth Subotnik, Keith Nuechterlein, Joseph Ventura, Gerhard S. Hellemann, Michael Gitlin — Posted 31 January 2011

Background Text
By Gunvant Thaker, Professor and Chief, Schizophrenia Related Disorders Program, Maryland Psychiatric Research Center and Deputy Editor, Schizophrenia Bulletin

In the September 2010 issue of Schizophrenia Bulletin, Remington and Kapur review preclinical and clinical literature on the effects of continuous versus intermittent antipsychotic drug treatment. This review paper draws interesting and provocative conclusions that challenge the established clinical lore regarding the optimal dosing of antipsychotic drugs. The authors point out that while a certain amount of D2 occupancy is critical for the antipsychotic response, continuous high occupancy is not needed. This would suggest that non-continuous antipsychotic dosing would be as effective as continuous dosing, and data from targeted antipsychotic treatment and drug holiday treatment trials support this approach.

Any treatment strategy that reduces total exposure to drugs has advantages and likely reduces side effects. However, does continuous treatment do more harm by modulating the responsivity to the treatment following extended use? This seems unlikely, although a thought-provoking question. The paper also challenges the benefit of extended release formulations. It is somewhat surprising that after half a century of antipsychotic medications, some of the fundamental questions such as frequency of dosing remain. As suggested by the authors, the field needs to focus on several questions in this context. What are effective alternatives to continuous antipsychotic drug treatment? Is the shift toward slow-release formulations wrong-headed? Should one invest in compounds with short half-lives?

Comments on Online Discussion
Comment by:  Donald Goff
Submitted 20 September 2010 Posted 20 September 2010

Remington and Kapur present a new and impressive challenge...  Read more

View all comments by Donald Goff

Comment by:  Herbert Meltzer (Disclosure)
Submitted 21 September 2010 Posted 21 September 2010

Remington and Kapur (  Read more

View all comments by Herbert Meltzer

Comment by:  Christoph U. Correll
Submitted 22 September 2010 Posted 22 September 2010

Antipsychotic Dosing: How Often Is Too Much and How...  Read more

View all comments by Christoph U. Correll

Comment by:  Giorgio MarcheseLuca Pani (Disclosure)
Submitted 22 September 2010 Posted 22 September 2010

The effort to optimize atypical antipsychotic treatment...  Read more

View all comments by Giorgio Marchese
View all comments by Luca Pani

Comment by:  Gloria Reeves
Submitted 24 September 2010 Posted 24 September 2010

This manuscript by Remington and Kapur (2010) raises some...  Read more

View all comments by Gloria Reeves

Comment by:  Bryan Roth, SRF Advisor
Submitted 27 September 2010 Posted 27 September 2010

Intermittent dosing of antipsychotic drugs:...  Read more

View all comments by Bryan Roth

Comment by:  Ripu JindalMatcheri S. Keshavan
Submitted 27 September 2010 Posted 27 September 2010

Consider intermittent dosing of antipsychotics, but...  Read more

View all comments by Ripu Jindal
View all comments by Matcheri S. Keshavan

Comment by:  David Mamo
Submitted 27 September 2010 Posted 27 September 2010

Directions in Antipsychotic Dosing: Proceed With...  Read more

View all comments by David Mamo

Comment by:  Srihari GopalDavid W. HoughKeith KarcherJustine Kent
Andreas Schreiner
Larry AlphsJoseph Palumbo
Submitted 27 September 2010 Posted 27 September 2010

Thank you very much for the invitation to provide...  Read more

View all comments by Srihari Gopal
View all comments by David W. Hough
View all comments by Keith Karcher
View all comments by Justine Kent
View all comments by Andreas Schreiner
View all comments by Larry Alphs
View all comments by Joseph Palumbo

Comment by:  John Kane
Submitted 29 September 2010 Posted 29 September 2010

Remington and Kapur have raised some important questions...  Read more

View all comments by John Kane

Comment by:  Jeffrey Lieberman, SRF Advisor
Submitted 28 October 2010 Posted 28 October 2010

“No thing is without poison. The dosage makes it either a...  Read more

View all comments by Jeffrey Lieberman

Comment by:  Gary RemingtonShitij Kapur (Disclosure)
Submitted 24 November 2010 Posted 24 November 2010

We would first like to thank those who took the time to...  Read more

View all comments by Gary Remington
View all comments by Shitij Kapur

Comment by:  Kenneth SubotnikKeith Nuechterlein (Disclosure)Joseph VenturaGerhard S. Hellemann
Michael Gitlin
Submitted 31 January 2011 Posted 31 January 2011

Remington and Kapur have challenged the existing dogma of...  Read more

View all comments by Kenneth Subotnik
View all comments by Keith Nuechterlein
View all comments by Joseph Ventura
View all comments by Gerhard S. Hellemann
View all comments by Michael Gitlin
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