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Potential Lower Efficacy of Molindone Among First-Generation Antipsychotics

To the Editor: In the November 2008 issue of the Journal, Linmarie Sikich, M.D., et al. (1) analyzed findings from the Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS) study. It was surprising to see that the authors selected molindone as the first-generation antipsychotic to compare with second-generation antipsychotics in the treatment of children and adolescents. Although treatment with molindone proved to be as efficacious as treatment with the second-generation antipsychotics assessed, other first-generation agents might have demonstrated superior efficacy. Unfortunately, clinical familiarity with first-generation antipsychotics (and with tricyclic antidepressants) is being lost to the detriment of some of our patients. As Baldessarini (2) warned, "molindone is not consistently as effective as other [first-generation] antipsychotic drugs" (2, p. 394). However, Sikich et al. noted in their study that molindone—among those patients for whom it is effective—does offer the distinct advantage of not causing weight gain.

Footnotes

The author reports no competing interests.

This letter (doi: 10.1176/appi.ajp.2009.08111696) was accepted for publication in January 2009.

References

1. Sikich L, Frazier JA, McClellan J, Findling RL, Vitiello B, Ritz L, Ambler D, Puglia M, Maloney AE, Michael E, De Jong S, Slifka K, Noyes N, Hlastala S, Pierson L, McNamara NK, Delporto-Bedoya D, Anderson R, Hamer RM, Lieberman JA: Double-blind comparison of first- and second-generation antipsychotics in early-onset schizophrenia and schizoaffective disorder: findings from the Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS) Study. Am J Psychiatry 2008; 165:1420–1431[Abstract/Free Full Text]
2. Baldessarini R: Chemotherapy, in The Harvard Guide to Modern Psychiatry. Edited by Nicholi AM. Cambridge, Mass, Harvard University Press, 1978, pp, 387–432

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