The Gut Microbiome and Treatment-Resistance in Schizophrenia

  • Mary V. SeemanEmail author
Review Article


The effect of antipsychotic medication is poor in 30–40% of patients with schizophrenia; treatment resistance is usually met with shifts to new drugs or drug augmentation strategies or a trial of clozapine. The purpose of this review was to examine the potential role of intestinal bacteria in the bioavailability of antipsychotic medication and the possibility that parenterally administered antipsychotics might be able to overcome treatment resistance. Databases were searched with appropriate terms to locate relevant papers dealing with the effect of antipsychotic drugs on the gut microbiome and the effect of bacterial metabolizing enzymes on antipsychotic drugs. Also searched were papers addressing the various current parenteral formulations of antipsychotic drugs. Sixty-five recent pertinent papers were reviewed and the results are suggestive of the premise that there is a drug refractory form of psychosis for which the composition of gut bacteria is responsible, and that parenteral drug administration could overcome the problem.


Gut microbiome Antipsychotic drugs Treatment resistance Parenteral formulations 


Compliance with Ethical Standards

Conflict of Interest

There is no conflict of interest. The author has nothing to disclose.

Ethical Approval

This is a review paper. No ethical approval was sought.

Informed Consent

This is a review paper. There was no need for consent.

Humans or Animals Participants

There was no research involving humans or animals.


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Authors and Affiliations

  1. 1.Department of PsychiatryUniversity of TorontoTorontoCanada

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