When symptoms persist: Clozapine augmentation strategies

Peter F Buckley, Alexander Miller, Jerry Olsen, David Garver, Del D. Miller, John Csernansky

Research output: Contribution to journalArticlepeer-review

113 Scopus citations


Recent data and clinical experience confirm that, in spite of superior efficacy for treatment-refractory schizophrenia, a substantial proportion of patients receiving clozapine will continue to experience disabling symptoms. Optimizing clozapine monotherapy is the first step in the management of "clozapine non-responders." Described here is a synthesis of the available literature on the range and efficacy of clozapine augmentation strategies that may be used when monotherapy fails. Treatment options include adjunctive antipsychotic medications, mood stabilizers, selective serotonin reuptake inhibitors, glycinergic agents, and electroconvulsive therapy. The evidence favoring one augmentation strategy over another is lacking; overall, adjunctive therapy is associated with only modest clinical improvement. Moreover, case series and open-labeled clinical trials dominate the extant literature, and there is a dearth of double-blind trials comparing these augmentation agents. Current systematic efforts to enhance the treatment of these patients with adjunctive therapies are worthy of being studied in carefully conducted clinical trials.

Original languageEnglish (US)
Pages (from-to)615-628
Number of pages14
JournalSchizophrenia Bulletin
Issue number4
StatePublished - 2001


  • Antipsychotic response
  • Augmentation
  • Clozapine
  • Schizophrenia
  • Treatment refractory

ASJC Scopus subject areas

  • Psychiatry and Mental health


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