Antidepressants show potential for managing depression in schizophrenia
Antidepressants may be effective for treating depression in patients with schizophrenia, according to a meta-analysis that underscores qualifying conclusions based on the small number of low- or moderate-quality studies.
Researchers performed a meta-analysis of 26 trials that included adult patients with schizophrenia or related psychosis who had a depressive episode. Based on the Cochrane risk bias tool, the quality of the studies was moderate to low.
Pooled data indicated that antidepressants (eg, selective serotonin reuptake inhibitors [SSRIs], tricyclic antidepressants) had a favourable effect on the risk of depression compared with placebo, with a small risk difference –0.19 (95 percent CI, –0.27 to –0.11) and corresponding number needed to treat of 5 (4 to 9).
The effect size was larger in studies using tools specifically designed to assess depression in schizophrenia. On sensitivity analysis, however, standardized mean difference of all antidepressants, as well as any individual antidepressant class, showed no statistically significant improvement in depression score at endpoint.
In light of the methodological limitations of current published findings, researchers recommend that future large-scale trials should prioritize the appropriate measurement of depressive symptoms in schizophrenia, include reporting of adverse outcomes, and use an adequate method of randomization, allocation, concealment and specific depression inclusion criteria.
Depression contributes to the extensive burden of schizophrenia, and its management is crucial to recovery. Improvement in depression status may result in better long-term functional outcomes, including medication adherence, service utilization, substance misuse, suicide attempts and quality of life. [Schizophr Res 2016;172:23–28]