Subscribe to Biological Therapies in Psychiatry -  Choose your plan >
May 2009

Treating Fibromyalgia
Antidepressants offer some relief for sufferers of fibromyalgia.

Donepezil in Schizophrenia?
A recent report suggests donepezil (Aricept) does not appear to benefit cognitive symptoms of schizophrenia.

Second-Generation Antipsychotics and the Risk of Cardiac Death
Second-generation antipsychotics produce about the same level of cardiac risks as first-generation agents.

Preventing Dementia
Higher levels of education, mentally challenging work, and moderate coffee consumption may protect against Alzheimer’s disease, but Ginkgo biloba does not.

In Brief
Mixed Results for Modafinil as an Adjunct in Schizophrenia; Memantine Not Efficacious as an Adjunct in Schizophrenia

In Brief

May 2009

Approved by the US Food and Drug Administration to treat narcolepsy and shift work sleep disorder, modafinil (Provigil) is purported to have cognitive-enhancing effects in patients with schizophrenia, and it has been used off-label to treat antipsychotic-associated sedation in this population. Saavedra-Velez and others reviewed six trials of modafinil as an adjunct to antipsychotic medications to treat cognitive deficits, negative symptoms, and fatigue in patients with schizophrenia: five randomized, prospective, double-blind, placebo-controlled trials and one open-label pilot study (J Clin Psychiatry 2009;70:104-112). Modafinil doses were 100 to 200 mg/day. The results were mixed. Of four studies that examined modafinil as an alerting agent for antipsychotic-induced fatigue and sedation, only the open-label study found a significant effect. Two studies found that modafinil did not improve negative symptoms. Three studies suggested that modafinil improves short-term memory, attention, and the ability to shift mental sets; three showed no effect of modafinil on cognition. The authors conclude that modafinil may have some efficacy in the treatment of antipsychotic-induced sedation and cognitive domains, but that more rigorous trials are needed before its overall effectiveness as an adjunctive treatment for schizophrenia can be determined. Modafinil was generally well tolerated. The main adverse event was a nonsignificant increase in risk of psychosis exacerbation.

In an 8-week, double-blind study, Lieberman and coworkers found no efficacy for another medication—memantine (Namenda)—as an adjunctive treatment for patients with schizophrenia (Neuropsychopharmacology 2009;34:1322-1329). Approved for the treatment of moderate to severe Alzheimer’s disease, memantine is an uncompetitive antagonist of glutamate receptors of the N-methyl-D-aspartate type. Memantine has been shown to be effective compared with placebo in delaying cognitive decline in patents with dementia. Memantine was considered as an adjunctive treatment for schizophrenia because the glutamatergic system has been implicated in the pathophysiology of this illness, and many patients treated with antipsychotics for schizophrenia have residual cognitive deficits. In this trial, 138 patients with schizophrenia were assigned to memantine, 20 mg/day, or placebo in addition to continuing treatment with atypical antipsychotics. At end point, total scores on the Positive and Negative Symptoms Scale did not differ between the memantine and the placebo groups. Memantine was associated with a higher incidence of adverse events (8.7%) than placebo (6.0%), and more subjects treated with memantine dropped out of the study due to adverse effects.

Heather S. Hopkins