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Adjunctive antidepressants safe, effective for depression in schizophrenia

Recent findings indicated antidepressants added to antipsychotics for schizophrenia had small, beneficial effects with low risk for exacerbation of psychosis and adverse effects.

“Antidepressants are prescribed to around 30% (range: 11% to 40%) of patients with schizophrenia. APA guidelines endorse management of depressive and negative symptoms with antidepressants, but the major British guidelines and the Schizophrenia Patient Outcomes Research Team do not offer such a recommendation due to a limited evidence base. This is a difficult situation, as people suffering from schizophrenia have a high risk of developing depressive symptoms, with the modal prevalence rate approaching 25% (range: 5% to 83%),” Bartosz Helfer, MSc, of Klinikum der Ludwig-Maximilians-Universität, Munich, and colleagues wrote.

To assess safety and efficacy of antidepressants added to antipsychotic drugs for schizophrenia, researchers conducted a systematic review and meta-analysis of 82 randomized controlled trials among 3,608 participants.

Adjunctive antidepressants were more effective than controls for depressive symptoms (standardized mean difference = –0.25; 95% CI, –0.38 to –0.12), negative symptoms (SMD = –0.3; 95% CI, –0.44 to –0.16), overall symptoms (SMD = –0.24; 95% CI, –0.39 to –0.09), positive symptoms (SMD = –0.17; 95% CI, –0.33 to –0.01), quality of life (SMD = –0.32; 95% CI, –0.57 to –0.06), and responder rate (risk ratio = 1.52, 95% CI, 1.29-1.78).

Effects on depressive and negative symptoms were more pronounced when minimum thresholds of these symptoms were inclusion criteria, according to researchers.

Antidepressants and controls did not significantly differ regarding exacerbation of psychosis, premature discontinuation and number of participants who experienced at least one adverse event.

More participants receiving adjunctive antidepressants experienced abdominal pain, constipation, dizziness and dry mouth, compared with controls.

“As indicated by the GRADE Summary of findings table, antidepressants added to antipsychotic drugs seem safe and efficacious and could be recommended in the treatment of depressive and negative symptoms of schizophrenia. As suggested by high-quality evidence, adjunctive antidepressants offer a reasonable balance between desirable and undesirable effects,” the researchers wrote. – by Amanda Oldt

Disclosure: Helfer reports no relevant financial disclosures. Please see the full study for a list of all authors’ relevant financial disclosures.