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ISSN: 1935-1232 (P)

ISSN: 1941-2010 (E)

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Abstract

Drug Treatment of Depressive Symptoms in Schizophrenia

Author(s): Hans-Jürgen Möller

Depressive symptoms during schizophrenic psychosis represent an important part of the overall spectrum of psychopathological symptoms, not only in the schizoaffective type but also in the core groups of schizophrenic psychosis diagnosed according to the International Classification of Diseases-10 (ICD-10) or the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). Their clinical relevance stems from the patients’ suffering and the association with suicide, as well as from the necessity to treat depressive symptoms in the context of schizophrenia. Besides the potential risk of inducing depressive symptoms, the first-generation antipsychotics seem to have a certain antidepressive effect, in the sense that depressive symptoms secondary to positive symptoms can be alleviated with the reduction of positive symptoms. The second-generation antipsychotics seem to have no risk to induce depressive symptoms, appear to have better antidepressive effects and, therefore, represent a better option for the treatment of depressive symptoms in schizophrenic patients. However, the evidence for this is based predominantly on ex post analyses of data from Phase III trials, and the results are not consistent. Administration of antidepressants in combination with antipsychotics seems to be a meaningful option to treat depressive symptoms in schizophrenia. However, data collected hitherto show that treatment with antidepressants in addition to neuroleptic treatment is only of limited benefit. This might especially be the case in combining antidepressants with second-generation antipsychotics. The risk of inducing positive symptoms by antidepressants has to be considered, although the evidence is limited in this respect. Furthermore, there is a risk of pharmacokinetic interactions, particularly with selective serotonin reuptake inhibitors (SSRIs)