Schizophrenia - are new treatments needed

The Lancet recently run a study looking at the use of cognitive therapy in people with schizophrenia

They found some benefit in terms of improvements in certain, but not all symptoms. Though the BBC claims that talking therapies are as good as drugs as there was no direct comparison between cognitive therapy and antipsychotics..

But having looked at the issue, it did strike me that antipsychotics are, well, a bit rubbish. A large amount of people stop using them due to side effects such as weight gain and drowsiness.

Is there any evidence that other drugs would be of more benefit - or anyone known of ongoing research into potentail new treatments for schizophrenia

7 Replies

  • Hi Gez,

    Thanks for highlighting this.

    I blogged about the Lancet RCT and highlighted the poor reporting of the study last week:

    My blog generated some quite vehement comments from both sides of the discussion, many of which were unfortunately of a trolling/spamming nature. It's clearly a very emotive topic for many.

    My blog was researched with input from 15 leading mental health experts. We highlighted a number of limitations of the trial and commented that the conclusions of the researchers were an overstatement of the evidence. The bottom line is that there is a risk of bias in the pilot trial results and they need to be replicated in a bigger study before changes are made in clinical practice.

    It's certainly true that antipsychotics are far from being a perfect treatment for people with schizophrenia. We know from the biggest trial to date comparing different kinds of antipsychotics, that as many as three quarters of patients with schizophrenia discontinue their drugs over 18 months, so this is a widespread problem and alternative treatments are badly needed:

    There is also emerging evidence about the dangers of long-term maintenance use of antipsychotics, for which there is very little evidence. This blog by my colleague Andrew Shepherd is a good summary of a recent JAMA Psychiatry 7 year follow up study on this topic:

    A good place to start, if you're looking for information about other drug treatments for schizophrenia, is the reviews page on the Cochrane Schizophrenia Group website:

    Most of their excellent reviews are about antipsychotics, but there are a number of other drugs that they research, including:

    Amino acids, enzymes, oils and nutritional agents

    Anti-convulsants / Convulsants


    Anti-movement disorders

    Anxiolytics / Hypnotics

    Central nervous system stimulants / Depressants


    They also cover a wide range of non-drug interventions.


    André (The Mental Elf)

  • Thanks for this. As a side note, I think you handled the resulting comments/trolling very well.

  • Thanks Rob, I appreciate that.

    There's no place for personal attacks in these kinds of discussions.

    Hopefully you'll always have a spirited but polite atmosphere on here. It seems pretty fluffy so far :-)



  • Cut & thrust, or fun & fluff - we're happy either way.

  • Having a partner who works with children with complex needs, I am very aware that there is no such thing as a Typical presentation of any condition - clinical or mental illness. There are often so many twists and turns that they might as well start giving the conditions numbers before they run out of names.

    This unfortunately also means that there will never be a perfect solution possible for any of these. This seems to be more apparent with mental illness, though this is only my ignorant impression.

    The trouble is, that many treatments do tend to engender a for/against sort of situation which can get quite aggressive - probably because often the results are not as clear cut (good or bad) as either side would like to pretend.

    Of course, none of this helps the poor patient stuck in the middle!

  • There's a great little blog here about the struggles that the BBC are having with this news story:

    The Beeb health news team have posted very contrasting headlines one month apart, the first highlighting a meta-analysis of 50 RCTs in the British Journal of Psychiatry: “Schizophrenia: talking therapy offers ‘little benefit’“ and the second (one month later) highlighting the new Lancet RCT that Gez flagged up in the original post: “Schizophrenia: Talking therapies `effective as drugs‘”.

    Interestingly the BBC headline on the second piece of research was edited over the weekend and now reads: "Schizophrenia: Talking therapies moderately effective".

    This is a story to keep an eye on as the authors of both the meta-analysis and the RCT are preparing commentaries on each other's work that will be published soon. Thoughtful journalism, not headline grabbing journalism is clearly needed here. I wonder who'll succeed in publishing news items that don't have to be hurriedly edited or retracted...

  • No one?

    There is only one safe way of writing an article about anything scientific:

    "Something really interesting is happening in science today - click here to go an read another persons report on it ...."


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