Pharmacological management of treatment-resistant schizophrenia: alternatives to clozapine
Other than for clozapine, there are no pharmacological interventions with robust evidence of a positive benefit–risk balance for the treatment-resistant schizophrenia. For patients with treatment-resistant schizophrenia, there is usually little to be gained, in comparison to switching the antipsychotic to clozapine, from alternatives such as a further switch to a non-clozapine antipsychotic medication, the prescription of high-dose or combined antipsychotic medications, or the augmentation of continuing antipsychotic medication with other medications, such as antidepressants, mood stabilizers, or benzodiazepines. However, where these are tried, each initiation of high-dose or combined antipsychotic medication or an augmentation strategy should be treated as an individual trial and appropriately monitored and reviewed, with discontinuation in case of inefficacy or benefit that is outweighed by safety or tolerability concerns.