Concurrent Use of Two Depot Antipsychotic Medications in Schizophrenia

Abstract

Schizophrenia is often associated with impaired insight and consequent non-adherence to treatment. To promote adherence the psychiatric practice has for decades included the administration of long-acting antipsychotic medication through an injectable intra-muscular route. In addition to this parenteral medication, persistent symptoms have sometimes necessitated the prescription of additional medication. A common scenario has included the provision of an oral atypical antipsychotic added to depot haloperidol or fluphenazine injections. However, non-adherence to the oral medicine remains a potential problem. To address this problem, one could administer two long-lasting intramuscular medications concurrently, one a typical and the other an atypical antipsychotic. This is a clinical practice for which a rationale exists but for which there is scarce empirical data to support it. We report the case of a patient who responded to treatment only after receiving a combination of both typical and atypical oral antipsychotics who was then transitioned to the depot formulation of both medications.