After 8 weeks, response rates were 34% among those treated with olanzapine, 46% among those treated with risperidone, and 50% among those treated with molindone, which were not significantly different.
Adverse events associated with treatment were common but were different between the two groups: Akathisia was significantly more common among those on molindone (18% had moderate or severe akathisia); weight gain was more common among those on one of the atypicals, particularly olanzapine; and prolactin levels increased significantly among those who were on risperidone only.
Noting that is was difficult to "rank the clinical importance of different adverse effects," the authors said the two newer drugs, "are likely to have persistent effects on long-term physical health, while those associated with molindone seem more likely to impact adherence" to treatment--although in this study, the dropout rate was not higher among these patients.
Molindone may have been weight neutral because of a possible rebound effect of previous treatment.
Benztropine, [greater than or equal to] 1 mg/d, was given to all patients treated with molindone, 14% of those treated with olanzapine, and 34% of those treated with risperidone to prevent or manage akathisia.
Among the 70 patients who completed treatment (25 of 40 with molindone, 17 of 35 olanzapine, and 28 of 41 with risperidone), more than one-half failed to achieve an adequate response.
Patients receiving molindone reported significantly higher rates of akathisia (P < .0008).
KOWATCH: The TEOSS trial found no significant differences in efficacy between molindone and the atypical antipsychotics (olanzapine and risperidone) included in the study.
I have found molindone to be quite effective in children with schizophrenia or schizoaffective disorder, especially in those who have gained a lot of weight on atypical antipsychotics.They usually lose weight on molindone.