Oral versus depot administration of neuroleptics in relapse prevention

Depot administration of neuroleptic drugs offers several advantages in the long-term maintenance therapy of chronic schizophrenic patients. The major advantage is the assurance of compliance leading to fewer relapses and rehospitalizations. Depot neuroleptics also eliminate bioavailability problems related to absorption and first pass metabolism and give a stable plasma concentration. Finally, depot neuroleptics assure better and safer possibilities to use the lowest effective dose principle, thereby reducing the frequency of side effects, including the subjectively distressing mental side effects such as akathisia, dysphoria and neuroleptic-induced deficit syndrome. Disadvantages include delayed disappearance of side effects after discontinuation and, for many patients, a feeling of being controlled. Administered in the proper way, with suitable information to the patient and relatives, depot neuroleptics improve the quality of the antipsychotic treatment, reduce relapse frequency, stabilize the therapeutic effect and diminish the level of side effects.