Adjunctive intranasal oxytocin reduces symptoms in schizophrenia patients
Abstract
Background Both human and animal studies suggest oxytocin may have antipsychotic properties. Therefore, we conducted a clinical trial to directly test this notion.Methods Nineteen schizophrenia patients with residual symptoms despite being on a stable dose of at least one antipsychotic were enrolled in a randomized, double-blind, crossover study. They received 3 weeks of daily intranasal oxytocin (titrated to 40 IU twice a day) and placebo adjunctive to their antipsychotics. Order of intranasal treatment was randomly assigned and there was a 1-week washout between treatments.Results Analysis of the 15 subjects who completed all the study visits revealed that oxytocin significantly reduced scores on the Positive and Negative Symptom Scale (p < .001) and Clinical Global Impression-Improvement Scale (p < .001) compared with placebo at the 3-week end point. No benefit was seen at the early time points. Oxytocin was well tolerated and produced no adverse effects based upon patient reports or laboratory analysis.Conclusions The results support the hypothesis that oxytocin has antipsychotic properties and is well tolerated. Higher doses and longer duration of treatment may produce larger benefits and should be evaluated in future studies.
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The acute increase in pro-social behavior, specifically time spent in contact, in male prairie voles following intranasal oxytocin resembles findings in many human studies.
“The acute effects of intranasal OT that we found here resemble those found in many human studies, consisting of an increase in pro-social behavior and engagement (specifically time spent in contact in males)(13,15,64–66).”
From Chronic intranasal oxytocin causes long-term impairments in partner preference formation in male prairie voles (2013) · cites this paper as [66]
Similar doses of oxytocin have been administered to subjects in previous studies of social functioning.
“Similar doses of OT have been administered to subjects in previous studies of social functioning (Andari et al., 2010; Feifel et al., 2010; Guastella et al., 2008; Hollander et al., 2007; Ditzen et al., 2009).”
From Effects of intranasal oxytocin on social anxiety in males with fragile X syndrome (2012) · cites this paper as Feifel et al., 2010
In patients with schizophrenia, an adjunctive 3-week treatment with intranasal OXT significantly improves Positive and Negative Syndrome Scale (PANSS) total scores and verbal memory measures of the California Verbal Learning Test.
“Furthermore, in patients with schizophrenia, an adjunctive 3-week treatment with intranasal OXT has been found to significantly improve Positive and Negative Syndrome Scale (PANSS) total scores (Feifel et al, 2010) and verbal memory measures of the California Verbal Learning Test (Feifel et al, 2012a).”
From Chronic and acute intranasal oxytocin produce divergent social effects in mice (2014) · cites this paper as Feifel et al, 2010
The efficacy of oxytocin administration depends on dosage.
“it has been proposed that the efficacy of oxytocin administration depends on dosage.10, 12, 13”
From Oxytocin efficacy is modulated by dosage and oxytocin receptor genotype in young adults with high-functioning autism: a 24-week randomized clinical trial (2016) · cites this paper as [12]
A dose of 40 IU oxytocin twice a day is comparable to the doses previously used in human studies investigating effects of multiple treatments of oxytocin and does not produce significant side effects or adverse outcomes.
“A dose of 40 IU twice a day is comparable to the doses previously used in human studies investigating effects of multiple treatments of oxytocin [61,62] and does not produce significant side effects or adverse outcomes [63].”
From Efficacy of oxytocin administration early after psychotrauma in preventing the development of PTSD: study protocol of a randomized controlled trial (2014) · cites this paper as [61]
Support for the notion that an effect size of d = 0.4 adequately reflects the potential of oxytocin to reduce psychiatric symptoms stems from 2 previous studies on long-term intranasal oxytocin administration in the treatment of positive and negative symptoms in schizophrenia patients.
“Support for the notion that an effect size of d = 0.4 adequately reflects the potential of oxytocin to reduce psychiatric symptoms stems from 2 previous studies on long-term intranasal oxytocin administration in the treatment of positive and negative symptoms in schizophrenia patients [61,97].”
From Efficacy of oxytocin administration early after psychotrauma in preventing the development of PTSD: study protocol of a randomized controlled trial (2014) · cites this paper as [61]
The observed effect sizes in those studies were between d = 0.05 - 0.88 and d = 0.24 - .74, depending on the outcome measure.
“The observed effect sizes were between d = 0.05 - 0.88 [97] and d = 0.24 -.74 (for most outcomes around d = 0.4) [61], depending on the outcome measure.”
From Efficacy of oxytocin administration early after psychotrauma in preventing the development of PTSD: study protocol of a randomized controlled trial (2014) · cites this paper as [61]
The BONDS trial's dose of 40 IU intranasal oxytocin was based on two studies that examined prolonged intranasal oxytocin administration on clinical symptoms in psychiatric patient populations and observed favorable outcomes.
“We based our dose of 40 IU on 2 studies that examined the effects of prolonged intranasal oxytocin administration on clinical symptoms in (psychiatric) patient populations and observed favorable outcomes [61,62].”
From Efficacy of oxytocin administration early after psychotrauma in preventing the development of PTSD: study protocol of a randomized controlled trial (2014) · cites this paper as [61]
Early investigations provide some encouragement that oxytocin could prove a useful supplement to current treatment of both schizophrenia and drug addiction.
“Interestingly, early investigations provide some encouragement that oxytocin could prove a useful supplement to current treatment of both schizophrenia (Keri et al., 2008;Feifel et al., 2010) and drug addiction (You et al., 2001;Qi et al., 2009;Carson et al., 2010).”
From Oxytocin enhances pupil dilation and sensitivity to 'hidden' emotional expressions (2013) · cites this paper as Feifel et al., 2010
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“…as individuals with alexithymia, social anxiety disorder, and schizophrenia (Caldwell et al., 2009; Guastella et al., 2009b; Bartz et al., 2010; Feifel et al., 2010; Rubin et al., 2010; Luminet et al., 2011; Pedersen et al., 2011; Hall et al., 2012) as it has already been shown in autism…”
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Self-citationA human tendency to anthropomorphize is enhanced by oxytocin
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Quintana, D. S., Dieset, I., Elvsåshagen, T., Westlye, L. T., & Andreassen, O. A. (2017) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2016.12.004 · Cited by 39 · see citing works
Horta de Macedo, L. R., Zuardi, A. W., Machado-de-Sousa, J. P., Chagas, M. H. N., & Hallak, J. E. C. (2014) · Psychiatry Research · doi:10.1016/j.psychres.2014.07.082 · Cited by 35 · see citing works
Oxytocin administration modulates rats’ helping behavior depending on social context
Yamagishi, A., Okada, M., Masuda, M., & Sato, N. (2020) · Neuroscience Research · doi:10.1016/j.neures.2019.04.001 · Cited by 33 · see citing works
Is oxytocin a promising treatment for schizophrenia?
Feifel, D. (2011) · Expert Review of Neurotherapeutics · doi:10.1586/ern.10.199 · Cited by 29 · see citing works
Self-citationOxytozin: Evidenz für ein therapeutisches Potenzial des sozialen Neuromodulators
Eckstein, M., & Hurlemann, R. (2013) · Der Nervenarzt · doi:10.1007/s00115-013-3832-6 · Cited by 28 · see citing works
Oxytocin: an expansive review of its mechanisms, functions, and therapeutic potential
Ueda, Y. (2023) · World Journal of Advanced Research and Reviews · doi:10.30574/wjarr.2023.19.1.1499 · Cited by 5 · see citing works
- Authors
- Feifel, D., Macdonald, K., Nguyen, A., Cobb, P., Warlan, H., Galangue, B., Minassian, A., Becker, O., Cooper, J., Perry, W., Lefebvre, M., Gonzales, J., & Hadley, A.
- Affiliations
- University of California San Diego Medical Center (US)
- Corresponding author
- Feifel, David
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2010-10
- Volume
- 68
- Issue
- 7
- Pages
- 678-680
- ISSN
- 0006-3223 (ISSN-L)
- OpenAlex
- W1976654483
- Cited by
- 308
- References
- 19
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 14 · 2023: 13 · 2022: 11 · 2021: 16 · 2020: 7 · 2019: 12 · 2018: 9 · 2017: 20 · 2016: 31 · 2015: 34 · 2014: 30 · 2013: 43 · 2012: 30
- FWCI
- 22.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Stanley Medical Research Institute
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Social Psychology › Neuroendocrine regulation and behavior
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Keywords
- oxytocin, schizophrenia, adjunctive therapy, residual symptoms, intranasal administration, positive and negative symptoms, treatment tolerability
- MeSH terms
- Administration, Intranasal, Adult, Double-Blind Method, Female, Humans, Male, Middle Aged, Oxytocin, Psychiatric Status Rating Scales, Schizophrenia, Schizophrenic Psychology, Antipsychotic Agents, Treatment Outcome
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