Atypical antipsychotics for people with both schizophrenia and depression

Abstract

Background Many people (up to 50%) with schizophrenia also have co-morbid depression. It has been suggested that new atypical antipsychotic drugs are beneficial for people with the two diagnoses. Objectives To assess the effects of atypical antipsychotic drugs on people who have a diagnosis of both schizophrenia and depression. Search methods We searched the Cochrane Schizophrenia’s Group Register (to March 2006). We supplemented this by citation searching and personal contact with authors and relevant pharmaceutical companies. Selection criteria We included randomised clinical trials of atypical antipsychotic drugs used specifically for the treatment of people with a diagnosis of both schizophrenia and depression. Data collection and analysis We extracted data independently. For homogenous dichotomous data we calculated random effects, relative risk (RR), 95% confidence intervals (CI) and, where appropriate, numbers needed to treat (NNT) on an intention-to-treat basis. For continuous data, we calculated weighted mean differences (WMD). Main results We found 878 citations but were only able to include three studies (five reports). One trial found no significant difference between quetiapine and haloperidol for the outcome of ‘less than 50% reduction in PANSS score’ (n=180, RR 0.91 CI 0.8 to 1.0). Those allocated sulpiride had significantly lower depression scores compared with people given chlorpromazine (1 RCT, n=36, WMD CPRS −0.70 CI −1.2 to −0.2). Again, however, in the quetiapine versus haloperidol comparison, the continuous scoring did not highlight differences (1 RCT, n=180, WMD PANSS depression change −0.57 CI −1.4 to 0.30). When clozapine was compared with any other antipsychotic drug plus an antidepressant or placebo, clozapine constantly scored better on Hamilton scores (1 RCT, n=29, WMD vs antipsychotic + mianserin −5.53 CI −8.23 to −2.8; 1 RCT, n=32, WMD vs antipsychotic + meclobemide −4.35 CI −6.7 to −2.03; 1 RCT, n=33, WMD vs antipsychotic + placebo −6.35 CI −8.6 to −4.1). Authors’ conclusions There are too few data to guide patients, carers, clinicians or policy makers. Current practice has to be guided by evidence other than that derived from randomised trials and more trials in this important area are indicated.

Managing Suicide Risk in Patients with Schizophrenia

“…In treating depressive symptoms in patients with schizophrenia, clinicians should maximize the dose and duration of antipsychotic medications first, especially if patients are taking second-generation antipsychotic medications, since second-generation agents may have antidepressant properties. [119] The clinician should also be alert to the possibility of pharmacokinetic interactions. As an example, clozapine and fluvoxamine can exhibit significant interactions.…”

Elderly Patients with Schizophrenia and Depression: Diagnosis and Treatment

“…A recent review by Furtado and Srihari (91) determined that there are too few data at this time to make any definitive conclusions. In fact, the authors were only able to find three studies which addressed this issue and these were all trials in nonelderly samples.…”

Impact of Second-Generation Antipsychotics and Perphenazine on Depressive Symptoms in a Randomized Trial of Treatment for Chronic Schizophrenia

“…A recent meta-analysis of SGAs for people with both schizophrenia and depression included only 3 methodologically rigorous studies for which depression was the primary outcome. 23 The conclusion of this review was that there were insufficient data to guide patients, prescribers, caregivers, or policy makers and that further studies were warranted.…”