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Inhalt
- Medication Recommendation for Psychosis – Schizophrenia – Short Version
- Core Components of the Strategy
- 1. Intermittent Antipsychotic Treatment (Aripiprazole) – A-Type
- 2. Continuous Antidepressant Therapy (Bupropion) – SNDRI-AD
- 3. Supplementary Medication (SSRIs and Tricyclic Antidepressants)
- 4. Nutritional Supplementation
- Therapeutic Concept
- → Long Version ←
- → Current Print Version ←
Medication Recommendation for Psychosis – Schizophrenia – Short Version
Overview: The therapeutic approach is based on an interval-based use of an atypical antipsychotic (preferably aripiprazole) in combination with daily administered antidepressants (bupropion) to effectively address not only positive symptoms but, above all, negative and cognitive symptoms (such as impairments in working memory, attention, and executive functions).
Core Components of the Strategy
1. Intermittent Antipsychotic Treatment (Aripiprazole) – A-Type
- Application: Aripiprazole is not taken continuously; it is administered only when mild early warning symptoms occur for a treatment period of approximately 1–3 weeks, until the symptoms have completely subsided. Thereafter, aripiprazole is discontinued for about 2–6 months, during which continuously taken bupropion provides stability.
- Objective: This short-term use of aripiprazole is intended to control both positive and negative symptoms. The symptoms improve markedly at the beginning of the discontinuation phases; however, after 2–6 months without aripiprazole a deterioration occurs. As soon as this becomes apparent, aripiprazole should be resumed for 1–3 weeks so that bupropion can exert its full effect.
- Caution: Since bupropion is a strong inhibitor of CYP2D6, the dosage of aripiprazole may need to be reduced or halved if necessary (given the currently unclear data, it is advisable to monitor the medication with blood tests before and after the switch). Other medicinal agents metabolized via CYP2D6 may also be affected.
2. Continuous Antidepressant Therapy (Bupropion) – SNDRI-AD
- Dosage: Generally, 300–450 mg daily (often starting with a lower initial dose).
- Effect: Bupropion, taken continuously, stabilizes the course of the illness during the 2–6‑month discontinuation phase of aripiprazole. At the beginning of the discontinuation phase, it significantly improves cognitive functions and negative symptoms, reduces inner restlessness as well as mood swings, and diminishes the associated irritability. In addition, it supports smoking cessation. Because this strongly positive effect is time-limited, aripiprazole must be re-administered for a short period after approximately 2–6 months.
- Caution: Bupropion is a strong inhibitor of CYP2D6, which can lead to elevated blood levels of aripiprazole – as well as other medications metabolized via CYP2D6. It is effective exclusively for smoking cessation and is ineffective for other addictions. Moreover, the antidepressant effect of the antidepressants diminishes over time, which is why aripiprazole must be instituted as soon as marked deterioration occurs. Aripiprazole also appears to work more reliably as an antidepressant than the antidepressants (bupropion & citalopram), which are primarily intended to improve negative and cognitive symptoms.
3. Supplementary Medication (SSRIs and Tricyclic Antidepressants)
- Citalopram (10–40 mg) – SSRI-ADAlternatives:Escitalopram, Sertraline
- Effect: Citalopram dampens emotional hyperexcitement, regulates an exaggerated libido (sexual excitability), and alleviates accompanying depressive symptoms. Side effects of bupropion, such as urinary disturbances and constipation, can thereby be effectively and prophylactically managed.
- Caution: Cognitive functions may deteriorate slightly during transition phases. Also, inner restlessness tends to be enhanced, which is why bupropion – with its calming effect – should be established first.
- Alternative: Sertraline and Escitalopram might represent better alternatives. Other SSRIs, such as fluoxetine, require clinical and laboratory monitoring due to unclear interactions (further CYP2D6 inhibition).
- Trimipramine Drops (40 mg/ml) – Tricyclic AD
- They are used in a low dosage (approximately 10–20 drops in the evening) to prevent sleep disturbances and alleviate addiction problems (e.g., with alcohol) – especially in phases when the stimulating effect of bupropion becomes more pronounced.
- Caution: Trimipramine is urgently necessary, especially in cases of addiction problems, as financial, gambling, and alcohol addictions are considered risk factors in this treatment concept. Affected individuals should secure their finances and avoid risky speculation or excessive (unnecessary) purchases. Trimipramine can help address such issues. The regular interval phases of aripiprazole are at least as important for effectively combating addictions – which are often associated with a mild delusion and mania.
4. Nutritional Supplementation
- Supplements: Vitamin B6, B‑Complex and Magnesium.
- Benefit: These supplements can reduce inner restlessness as well as akathisia and promote overall well-being.
- Caution: Vitamin B6 should be administered in a therapeutic dose of approximately 50–300 mg. In cases of medication-induced akathisia or severe inner unrest during the discontinuation phases, temporarily higher dosages (400 to 1200 mg in a short period) are possible. Since peripheral neuropathy may occur from 200 mg onward, higher doses for akathisia should only be applied briefly or under medical supervision. Magnesium has a positive influence on schizophrenia, and a high‑dose B‑Complex (all 8 B vitamins) can also serve as a valuable supplement to Vitamin B6.
+ Vitamin B6, magnesium and B-complex
