ABSTRACT
Since the discovery that clozapine induces less extrapyramidal side effects (EPSE) and is more effective than conventional antipsychotics for the treatment of schizophrenia (Kane et al, 1988; Wahlbeck et al, 1999), psychopharmacological research has for a long time focused on the development of drugs which have higher affinity for 5-HT2 receptors than for D2 receptors. It has been postulated that the ‘atypical’ profile of the new antipsychotic drugs olanzapine, quetiapine, risperidone and ziprasidone has mainly been linked to a combined antagonism of central serotonin (5HT2) and dopamine (D2) receptors (Roth and Meltzer, 1995; Buckley, 1997). However, the ‘dopamine alone’ hypothesis of antipsychotic drug action has recently seen a renaissance, to which the work of many authors of this book has contributed. In this context, the clinical data obtained with amisulpride have been very important. This drug, which has been used as an antipsychotic in France for more than 10 years, does not block serotonin receptors at all, but shows high affinity and selectivity for dopamine D3/D2 receptors, at which it is an antagonist. The pivotal clinical trials performed with amisulpride have demonstrated a lower risk of EPSE and a higher efficacy against negative symptoms compared to conventional antipsychotics. The present authors therefore performed a meta-analysis to compare indirectly the clinical effects of amisulpride with those of the 5-HT2/D2 antagonists.
