Efficacy and safety of antidepressant augmentation of continued antipsychotic treatment in patients with schizophrenia

Galling, Britta; Vernon, J A; Pagsberg, Anne Katrine; Wadhwa, Akhilesh; Grudnikoff, Eugene; Seidman, Andrew J.; Tsoy-Podosenin, Marina; Poyurovsky, Michael; Kane, John M.; Correll, Christoph U.

doi:10.1111/acps.12854

Cited by 67 publications

(53 citation statements)

References 93 publications

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“…ADs were often prescribed for negative and depressive symptoms and cognitive impairment in schizophrenia . Negative and depressive symptoms could be improved in around a third of schizophrenia patients receiving ADs and adjunctive ADs . This may be related to the effect of ADs in modifying serotonergic (5‐HT) dysfunction that is thought to be involved in the pathophysiology of psychotic symptoms …”

Section: Discussionmentioning

confidence: 99%

“…29 Negative and depressive symptoms could be improved in around a third of schizophrenia patients receiving ADs 30,31 and adjunctive ADs. [32][33][34] This may be related to the effect of ADs in modifying serotonergic (5-HT) dysfunction that is thought to be involved in the pathophysiology of psychotic symptoms. 14,35,36 Although AD monotherapy has been recommended in treating depressive disorders, 37 adjunctive APs are often used as an augmentation strategy for treatment-resistant depression.…”

Section: Discussionmentioning

confidence: 99%

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Concurrent antipsychotic use in older adults treated with antidepressants in Asia

et al. 2019

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Aim Depressive disorders are common in old age. Antipsychotics (APs) are often used as an adjunctive treatment with antidepressants (ADs) in this population but its patterns of use in Asia are not known. This study explored the rate of combination of APs and ADs in older adult psychiatric patients in Asia. Methods This is a secondary analysis of the database of a multicentre study which recorded participants’ basic demographical and clinical data in standardised format in 10 Asian countries and territories. The data were analysed using univariate and multivariate logistic regression analyses. Results A total of 955 older adult psychiatric in‐ and outpatients were included in this study. The proportion of concurrent AP and AD use was 32.0%, ranging from 23.3% in Korea to 44.0% in Taiwan. Multivariate logistic regression analysis found that younger age, inpatient status and diagnosis of schizophrenia, anxiety and other mental disorders were significantly related to a higher proportion of concurrent use of APs and ADs. Conclusion Around a third of older adult psychiatric patients had concurrent AP and AD use in the Asian countries/regions surveyed. Considering the uncertain effectiveness and questionable safety of the AP and AD combination in this patient population, such should be cautiously used.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Concurrent antipsychotic use in older adults treated with antidepressants in Asia

et al. 2019

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“…Antipsychotics affect especially positive symptoms, whereas for negative symptoms and cognitive impairment, they are less effective [3]. Antidepressant (AD) or mood stabilizer (MS) use as adjuvants to antipsychotics has been investigated in treatment for symptoms such as depressive and negative symptoms [4] and aggression [5], but they are rarely recommended in clinical guidelines due to lack of high quality evidence of their efficacy [3,6,7]. Evidence on benefits in clinical trials is mixed which was represented by a recent study reporting that add-on citalopram was associated with reduced levels of negative symptoms but had no impact on depressive symptoms [8].…”

Section: Introductionmentioning

confidence: 99%

Use of antidepressants and mood stabilizers in persons with first-episode schizophrenia

Puranen

Koponen

Tanskanen

et al. 2020

Eur J Clin Pharmacol

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Purpose Antipsychotics are first-line treatment of schizophrenia. They are often accompanied by adjunctive treatments, such as antidepressant (AD) or mood stabilizer (MS), although there is only limited information of their use in first-episode schizophrenia. This study aimed to investigate AD and MS initiation and factors associated with initiation in persons with first-episode schizophrenia. Methods Register-based data was utilized to identify persons who received inpatient care due to schizophrenia during 1996-2014 in Finland and who did not use AD or MS at the time of first inpatient care diagnosis of schizophrenia (N = 7667, mean age 40.2, SD 18.2). Drug purchase data (1995-2017) was obtained from the National Prescription register and modelled with PRE2DUP method. Initiations of AD and MS use were followed up 3 years from first schizophrenia diagnoses. Cox proportional hazard models were used to investigate factors associated with AD or MS initiation. Results Among persons with first-episode schizophrenia, 35.4% initiated AD and 14.1% initiated MS use within three years from diagnoses. Female gender, younger age, and benzodiazepine use were associated with higher risk of AD and MS initiation. The number of previous psychoses was associated with decreased risk of AD and increased risk of MS initiation. Conclusion Clinical guidelines rarely recommend the use of AD or MS as adjunctive treatment in persons with schizophrenia. However, this population is often treated with AD or MS. More studies are needed to evaluate benefits and risks of these medications as adjunctive treatment of schizophrenia.

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“…Trials are needed that are as large and well conducted as BeneMin, but such studies should focus on more severely ill patients with prominent negative symptoms, either testing minocycline in patients with inflammation, or comparing different antidepressants4 or other putative agents that could be effective for negative symptoms. Furthermore, an individual-patient-data meta-analysis might help to understand whether minocycline or antidepressants or other agents act differentially on patients with different symptomatic phenotypes 5…”

Section: What Next In Researchmentioning

confidence: 99%

Adjunctive minocycline in schizophrenia: what one well-conducted study can tell us (and what it can’t)

Solmi

Correll

2019

Evid Based Mental Health

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Efficacy and safety of antidepressant augmentation of continued antipsychotic treatment in patients with schizophrenia

Cited by 67 publications

References 93 publications

Concurrent antipsychotic use in older adults treated with antidepressants in Asia

Concurrent antipsychotic use in older adults treated with antidepressants in Asia

Use of antidepressants and mood stabilizers in persons with first-episode schizophrenia

Adjunctive minocycline in schizophrenia: what one well-conducted study can tell us (and what it can’t)

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