Relapse More Likely With Antipsychotic Switch in Schizophrenia, Bipolar Disorder, or MDD

Patients with schizophrenia or a mood disorder who switched antipsychotic treatment had an increased likelihood for relapse, healthcare resource utilization, and extrapyramidal symptoms.

Patients with schizophrenia, bipolar disorder, or major depressive disorder who switched antipsychotics were more likely to have a relapse and within a shorter amount of time than patients who did not switch, according to results presented at Psych Congress 2019, held October 3 to 6 in San Diego, California. Patients who switched also had an increased likelihood of healthcare utilization and diagnosis of extrapyramidal symptoms.

Investigators used Medicaid data gathered between 2008 and 2017 from 6 US states (Iowa, Kansas, Mississippi, Missouri, New Jersey, and Wisconsin). Patients selected were 18 to 65 years old; had a diagnosis of bipolar disorder, major depressive disorder, or schizophrenia; and had ≥2 refills of an oral antipsychotic medication postdiagnosis. Patients who switched had stable-dose monotherapy for ≥90 days before a change in treatment and patients who did not switch had stable-dose monotherapy for ≥91 days. Patients were followed for 2 years after the index change until treatment change, end of eligibility, age 65 years, or the end of the study period.

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Continuous variables and dichotomous variables were evaluated using Wilcoxon signed-rank and McNemar tests, respectively; multivariable Cox hazard models were also used.

A final cohort comprised 10,548 patients who switched antipsychotic medications and 31,644 who remained on their original medication. Patients who switched antipsychotic medications were more likely to have a relapse (adjusted hazard ratio, 1.36; 95% CI, 1.28-1.44; P <.001), and had a shorter time to disease relapse than those who did not switch (P <.001). Similarly, patients who switched were more likely to have a psychiatric admission, inpatient admission, or emergency department visit within a shorter time during the study period (P <.001).

When considering extrapyramidal symptoms, first diagnosis was more likely to happen during the study period for patients who switched antipsychotic medications (adjusted hazard ratio, 1.28; 95% CI, 1.06-1.55; P <.05).

“Decisions on antipsychotic switching for patients who require maintenance antipsychotic treatment should be individualized and carefully considered, taking into account the potential risk of relapses in some patients with [schizophrenia, bipolar disorder, or major depressive disorder],” investigators concluded.

For more coverage of Psych Congress 2019, click here.

Disclosure: This study was funded by Teva Pharmaceutical Industries. All authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Carroll B, Ayyagari R, Thomason D, Mu F, Philbin M. Impact of antipsychotic treatment switching in patients with schizophrenia, bipolar and major depressive disorders. Presented at: Psych Congress 2019; October 3-6, 2019; San Diego, CA. Poster 117.