BACKGROUND: There are virtually no controlled data suggesting that concomitant 
psychotropic medications (CPMs) improve outcome in schizophrenia after the acute 
phase. Despite that, polypharmacy (with all of its disadvantages) is far more 
common than monotherapy. To our knowledge, there have been no published reports 
of prospective systematic investigations of the efficacy of unrestricted CPM use 
in nonacute schizophrenia.
METHOD: This was a naturalistic, systematic study using a sample of 53 
stabilized patients with DSM-IV-TR schizophrenia from 1 clinical practice 
setting including both private patients and patients from controlled research 
studies of the effectiveness of antipsychotics. Since there are meager 
controlled or systematic data on the effectiveness of CPM use with 
antipsychotics in nonacute schizophrenia, we tested the clinical strategy of CPM 
use by gradually tapering all CPMs (except antianxiety agents). The aim was to 
determine if the CPM improved outcome, had no effect, or worsened outcome using 
the Clinical Global Impressions-Improvement scale before and after taper, over 
at least 3 months and in some cases up to 18 months after discontinuation. Data 
were gathered from July 2002 to June 2005.
RESULTS: For 21 patients undergoing 22 antidepressant tapers, no change was 
noted in 18 of 22 tapers, while in 3 improvement was noted and in 1 worsening 
was noted. For the 12 patients on treatment with mood stabilizers, no change was 
noted in 10 of 13 discontinuations, while in 3 mild worsening was noted. One 
patient was on treatment with both modafinil and trazodone and reported no 
change after tapering each in separate discontinuation trials, while another 3 
patients were taking sleeping medications and also noted no change after 
discontinuation.
CONCLUSION: For most stabilized, chronic patients with schizophrenia, tapering 
adjunctive medications did not change outcome. This naturalistic study further 
defines the limits of efficacy of some concomitant classes of medications in 
patients with chronic schizophrenia who are already receiving adequate 
antipsychotic therapy.