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Pharmacopsychiatry 2014; 47(06): 185-194
DOI: 10.1055/s-0034-1383656
Review
© Georg Thieme Verlag KG Stuttgart · New York

Clozapine Augmented with Glutamate Modulators in Refractory Schizophrenia: A Review and Metaanalysis

S. R. T. Veerman
1   Flexible Assertive Community Treatment, Mental Health Service ­Organisation North Holland North, Community Mental Health Division, Alkmaar, The Netherlands
,
P. F. J. Schulte
2   Treatment Centre for Bipolar Disorders, Mental Health Service ­Organisation North Holland North, Division for Specialised Treatment, Alkmaar, The Netherlands
,
M. J. H. Begemann
3   Neuroscience Department & Rudolf Magnus Institute for Neuroscience, UMCU, University Medical Center Utrecht, Utrecht, The Netherlands
,
F. Engelsbel
4   Research Department, Mental Health Service Organisation North Holland North, Heerhugowaard, The Netherlands
,
L. de Haan
5   Early Psychosis Department, AMC, Academic Psychiatric Centre, ­Amsterdam, The Netherlands
› Author Affiliations
Further Information

Publication History

received 14 May 2014

accepted 11 June 2014

Publication Date:
07 July 2014 (online)

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Abstract

Clozapine is an efficacious antipsychotic drug for patients with treatment-resistant schizophrenia, but does not sufficiently improve these symptoms in a substantial proportion of this population. There is no convincing evidence for the efficacy of any clozapine augmentation strategy. New evidence suggests that glutamate receptors are a candidate target for therapeutic effects in schizophrenia. We present an overview of studies assessing the potential clinical utility of adding glutamatergic agents to clozapine. We conducted 3 metaanalyses of data on positive, negative and overall symptoms of schizophrenia, analysing results from 3 studies on clozapine augmentation with glycine, 6 studies on lamotrigine add-on therapy to clozapine and 4 studies on topiramate addition to clozapine.

Key words

schizophrenia - refractory disease - augmentation - clozapine - glutamate
 

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