Carbamazepine Augmentation for Schizophrenia: How Good Is the Evidence?
J Clin Psychiatry 2002;63(3):218-224
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Augmentation strategies
in schizophrenia treatment remain an important issue because despite the introduction of
several new antipsychotics, many patients remain
treatment resistant. The aim of this study was to
undertake a systematic review and meta-analysis of the safety and efficacy of one frequently
used adjunctive compound: carbamazepine.
Data sources and study
selection: Randomized controlled trials comparing
carbamazepine (as a sole or as an adjunctive compound)
with placebo or no intervention in participants
with schizophrenia or schizoaffective disorder
were searched for by accessing 7 electronic
databases, cross-referencing publications cited in
pertinent studies, and contacting drug companies
that manufacture carbamazepine.
Method: The identified studies were
independently inspected and their quality assessed by
2 reviewers. Because the study results were generally incompletely reported, original patient
data were requested from the authors; data were received for 8 of the 10 randomized controlled
trials included in the present analysis, allowing for
a reanalysis of the primary data. Dichotomous variables were analyzed using the
Mantel-Haenszel odds ratio and continuous data were
analyzed using standardized mean differences, both
specified with 95% confidence intervals.
Results: Ten studies (total N=283
subjects) were included. Carbamazepine was not
effective in preventing relapse in the only randomized
controlled trial that compared carbamazepine monotherapy with placebo. Carbamazepine tended
to be less effective than perphenazine in the only trial comparing carbamazepine with an
antipsychotic. Although there was a trend indicating
a benefit from carbamazepine as an adjunct to antipsychotics, this trend did not reach statistical
Conclusion: At present, this
augmentation strategy cannot be recommended for routine
use. The most promising targets for future trials
are patients with excitement, aggression, and
schizoaffective disorder bipolar type.