Add-On Antidepressants for Patients with Schizophrenia

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High-quality evidence supports antidepressant–antipsychotic combinations, and perhaps particularly for patients with marked depressive or negative symptoms.

Patients with schizophrenia often develop depressive symptoms, and about 30% receive antidepressants. In individual studies, adding antidepressants to antipsychotics benefited these patients, but changes in practice often require more substantial evidence. Now, investigators have systematically reviewed 82 randomized, controlled studies (91% double-blind) published in 1964–2014 involving 3608 patients with schizophrenia who received antipsychotics plus antidepressants or control (placebo or no adjunctive treatment).

Participants were inpatients or outpatients (61% male; mean age, 40; mean duration of illness, 11 years; mean chlorpromazine equivalents, 604 mg/day). Overall, add-on antidepressants (mean fluoxetine equivalent, 31 mg/day) were superior to controls in alleviating depressive symptoms (number needed to treat [NNT], 9), negative symptoms (NNT, 9), overall symptoms (NNT, 14), positive symptoms (NNT, 14), and quality of life (NNT, 9). Compared with controls, antidepressants did not exacerbate psychosis or increase premature discontinuation due to ineffectiveness or adverse effects.

Effect sizes for adjunctive treatment showed a trend to be larger for subpopulations with more pronounced depressive symptoms, postpsychotic depression, and negative symptoms. No differences were found in analyses of individual antidepressants, although several (monoamine oxidase inhibitors as a group, amitriptyline, duloxetine, sertraline, and trazodone) seemed individually better than controls. Selective serotonin reuptake inhibitors (particularly citalopram and fluvoxamine) appeared to improve negative symptoms.

Related Reading:

How Antidepressant and Antipsychotic Medications Work
http://www.heretohelp.bc.ca/visions/medications-vol4/how-antidepressant-and-antipsychotic-medications-work

Antidepressants in Treatment of Schizophrenia

Antidepressants for people with both schizophrenia and depression

Vitamins and Supplements for Depression:

A New Tool in the Antidepressant Toolbox? Sarcosine, found in muscles and other body tissues, improved mood better than a popular antidepressant

‘Anti-Ketamine’ Agents May Also Ease Depression

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Antidepressants are a big no no for me.

They can trigger or worsen psychosis and/or mania.

Antidepressants are not for everyone.

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I used to think an antidepressant started my schizophrenia and resisted taking them. The one I was taking when I became ill (tofranil) indeed had a black box warning stating it should not be given to people with schizophrenia. However when I was put on trazadone and lexapro my insomnia and depression were significantly improved without a worsening of the psychosis. So I guess it depends on which one it is.

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When I first saw my current psychiatrist, he put me on Lexapro for anxiety, just a low dose.

Now my dose has increased threefold to help with depression I have recently been going through. It think it might finally be starting to crack the shell of this deep depression.

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I was on Tofranil for years - it made me nuts!

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I was given high dose Prozac, mainly for obsessionality. Have really benefitted from it. Pretty sure it has helped my negative symptoms. Or maybe I was slightly depressed and it has treated that.

Either way I like my antidepressants. Can totally see why they are not for everyone though.

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I pass…makes me want to commit sepuko…but i can see how it helps lots of people…

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I’m on Prozac, before that it was zoloft. Almost always been on that plus an ap. then around 2011 my pdoc put me on lamictal, a mood stabilizer, to even out the mania a bit. so prozac sends me up, lamictal balances me out (it’s also good for getting me to clean my room).

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I sometimes like to complain that people with sz can’t take antidepressants, but we still have symptoms that can overlap a bit with depression. I’ll try it the day my pdoc approves it. Otherwise, I am in the skeptical camp.

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Last time I had a stand alone Antidepressant was early 1975. It was before my first admission and the first psych drug I was on was anafranil.
Since then times on an AD have been when I was already on a mood stabiliser or an antipsychotic.
When I went off meds under doctor’s say so for a year and then had to go back on the pdoc rejected me going on a stand alone AD. His reason- the possible negative effect on my moods.
Although no longer dxed S/A or bipolar, and the mood element of my illness had been played down, I guess he was erring on the side of caution.

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Pass…side effects whore me on all the ad ive ever had…if they try to make me take them ill say ok…and throw them away…