Adjunctive Medications

  • Oliver Freudenreich
Part of the Current Clinical Psychiatry book series (CCPSY)


Schizophrenia is a syndrome with psychotic and nonpsychotic dimensions. Antipsychotics primarily treat the psychotic symptom cluster, and clinicians often add adjunctive medications to target symptoms not fully addressed by antipsychotics (e.g., depression, anxiety, insomnia) or to manage side effects (e.g., extrapyramidal side effects). This chapter reviews the benefits but also the risks of several medication categories that are frequently used in addition to backbone treatment with antipsychotics: antidepressants, anxiolytics and sedative-hypnotics, antiepileptic drugs, lithium, and anticholinergics. A section on herbal remedies and supplements concludes this chapter.


Add-on strategies Nonpsychotic symptom clusters Depression Antidepressants Anxiolytics Benzodiazepine indications Insomnia Sedative-hypnotics Antiepileptic drugs Lithium Valproate Carbamazepine Oxcarbazepine Topiramate Anticholinergics Herbal remedies Supplements 


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Additional Resources


    1. European Medicines Agency. Valproate and related substances. 2018. Available from: Accessed on 7/1/19. – As my contribution to safe prescribing, I discourage the use of valproate in women with childbearing potential unless there is a clear indication for.


    1. Correll CU, Rubio JM, Inczedy-Farkas G, Birnbaum ML, Kane JM, Leucht S. Efficacy of 42 pharmacologic cotreatment strategies added to antipsychotic monotherapy in schizophrenia: systematic overview and quality appraisal of the meta-analytic evidence. JAMA Psychiatry. 2017;74:675–84. – An extensive review of the literature on adjunctive approaches, with no clear winner.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Oliver Freudenreich
    • 1
  1. 1.Department of PsychiatryMassachusetts General HospitalBostonUSA

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