Study finds antidepressants may help in treating schizophrenia
Schizophrenia is a complex and chronic mental disorder affecting more than 2 million people in the United States.
Finding appropriate medication to address the various symptoms of schizophrenia and improve the quality of life of these individuals is a constant challenge for psychiatrists and other health care professionals.
While antipsychotic medication remains the primary form of treatment for the so-called positive symptoms of schizophrenia (delusions, hallucinations, thought disorders), there is mounting interest in the medical community in using antidepressants combined with antipsychotics as a treatment for the disorders negative symptoms. The negative symptoms of schizophrenia are similar to those found in individuals with depression and are characterized by a lack of motivation or desire, lack of social relationships, and blunted affect and emotion.
Megan Ehret, a University of Connecticut pharmacologist specializing in mental disorders, recently surveyed the records of more than 1,500 schizophrenic patients at a Hartford, CT mental health center and found that more than 1 in 4 patients were given antidepressants as add-on medications at time of discharge.
While the reasons the patients received antidepressants were not identified in the study, Ehret notes that a vast majority of the patients did not have a co-diagnosis of depression, anxiety, or personality disorder. Ehret concludes, therefore, that the antidepressants were most likely given for the treatment of the negative symptoms of schizophrenia and the patients depressive state.
This is a potentially important contribution to the field as there has been increased interest in recent years about both depressive and so-called negative symptoms that seem to occur in some patients with schizophrenia but not all, says Dr. John W. Goethe, a psychiatrist and director of the Burlingame Center for Research and Education at the Institute of Living (IOL) in Hartford, where the study took place. Goethe served as a co-author of the study, along with Bonnie L. Szarek, a research nurse and project coordinator at the IOL, which is a division of Hartford Hospital.
Prior studies suggest that in clinical practice there has been an increase in prescribing antidepressants along with the usual antipsychotic medications that these patients receive, Goethe says. While the rationale for this recently observed prescribing practice can only be inferred, it is possible that it is related to clinician-perceived depressive and/or negative symptoms that co-exist with the psychotic symptoms, such as hallucinations and delusions.
While more research is warranted, the results suggest that the diagnostic criteria associated with the symptoms of schizophrenia, and other related illnesses such as schizoaffective disorder, may need to be more clearly defined and related treatment protocols amended to reflect a growing use of antidepressants by the medical community.
Right now people are using antidepressants in schizophrenia for a variety of reasons, Ehret says. There is a lot of discussion in the area of psychology as to whether we are truly diagnosing schizophrenia or whether we are diagnosing schizoaffective disorder, which is another type of schizophrenia but has more of a mood component to it. There are many different reasons to use antidepressants and we want to be sure we are using them appropriately.
The distinction in diagnosis is important as the American Psychiatric Association is in the process of amending its Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) and reviewing its definitions of different psychiatric illnesses. The APA expects to publish a new version, the DSM-V, in 2013. The manual is the primary resource for the diagnosis of psychiatric illnesses used by mental health professionals.
Ehret, an assistant professor of pharmacy practice in the University of Connecticuts School of Pharmacy, presented her findings at the APAs annual meeting in Hawaii in May. Goethe praised Ehrets research and said he was unaware of any prior study that looked at so many demographic and clinical variables related to antidepressant use among schizophrenic patients or one that involved such a large patient sample.
The details of the study are as follows: Ehret reviewed the case histories of 1,519 patients diagnosed with schizophrenia at the IOL between February 2000 and July 2009. The patients ranged in age from 18 to 64 with 40 being the average age. Of that total, 425 or 28 % were discharged on antidepressants, mainly selective serotonin reuptake inhibitors (SSRIs).
Ehret said she was a bit surprised by the regularity with which the drugs were being prescribed.
Twenty-eight percent is more than a quarter of the patients; thats a substantial number to think about when the use of antidepressants is not high up on the treatment protocol, Ehret says.
The study showed that what type of schizophrenia a patient had catatonic, paranoid, disorganized or the undifferentiated type made no significant difference in whether they received antidepressants. The patients age, sex, length of stay, and rate of readmission also did not appear to be a factor.
Interestingly, despite their regular use, antidepressants did not substantially reduce patients length of stay at the institution or reduce their readmission rate when compared to patients not on the drugs. Nor, says Ehret, did the use of antidepressant drugs appear to significantly increase length of stay, readmission rate, or cause substantial side effects when interacting with other drugs.
Right now all we can say with this study is that these antidepressants arent going to hurt you. Youre going to do at least as well as people who dont get them, Ehret says. We dont know how much better you can get with them. There have been several small studies showing you can get better, but we dont know.
If it is found that antidepressants do indeed improve the quality of life for patients with schizophrenia, than the current medical protocols may need to be amended, Ehret says. Clarifying the issue is important in the interest of providing quality care. Mental health professionals know that most patients with schizophrenia respond better the earlier treatment begins.
As a pharmacist, I know that the quicker you treat someone with schizophrenia, the better their long term prognosis, says Ehret. I also know that the more options you have available to a patient, the better. What we need to find out is is there a combination of antipsychotic medications and antidepressants that works best; should we alter the DSM guidelines; when is it best to start these medications and what is the best dose to start on?
Provided by University of Connecticut
- Schizophrenia misunderstood, psychiatrist says May 06, 2011 | not rated yet | 0
- Culture, stigma affect mental health care for Latinos Mar 23, 2011 | not rated yet | 0
- The war against mental illness Nov 17, 2010 | not rated yet | 0
- Violence declines with medication use in some with schizophrenia Jul 01, 2008 | not rated yet | 0
- Hospitalization more likely with mental health meds out of reach Dec 10, 2010 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
How can there be villous adenoma in colon, if there are no villi there
11 hours ago As title suggest. Thanks :smile:
How can there be a term called "intestinal metaplasia" of stomach
May 21, 2013 Hello everyone, Ok Stomach's normal epithelium is simple columnar, now in intestinal type of adenocarcinoma of stomach it undergoes "intestinal...
Pressure-volume curve: Elastic Recoil Pressure don't make sense
May 18, 2013 From pressure-volume curve of the lung and chest wall (attached photo), I don't understand why would the elastic recoil pressure of the lung is...
If you became brain-dead, would you want them to pull the plug?
May 17, 2013 I'd want the rest of me to stay alive. Sure it's a lousy way to live but it beats being all-the-way dead. Maybe if I make it 20 years they'll...
MRI bill question
May 15, 2013 Dear PFers, The hospital gave us a $12k bill for one MRI (head with contrast). The people I talked to at the hospital tell me that they do not...
Ratio of Hydrogen of Oxygen in Dessicated Animal Protein
May 13, 2013 As an experiment, for the past few months I've been consuming at least one portion of Jell-O or unflavored Knox gelatin per day. I'm 64, in very...
- More from Physics Forums - Medical Sciences
More news stories
A new study shows there is a gender gap when it comes to behavior and self-control in American young children – one that does not appear to exist in children in Asia.
Psychology & Psychiatry 1 hour ago | not rated yet | 0
Until now, little was scientifically known about the human potential to cultivate compassion—the emotional state of caring for people who are suffering in a way that motivates altruistic behavior.
Psychology & Psychiatry 2 hours ago | not rated yet | 1 |
What effect does a father's depression have on his young son or daughter? When fathers report a high level of emotional intimacy in their marriage, their children benefit, said a University of Illinois study.
Psychology & Psychiatry 3 hours ago | not rated yet | 0
(Medical Xpress)—Preschoolers universally recognize that one's choices are not always free – that our decisions may be constrained by social obligations to be nice to others or follow rules set by parents ...
Psychology & Psychiatry 10 hours ago | not rated yet | 0
(Medical Xpress)—Do ethicists engage in better moral behavior than other professors? The answer is no. Nor are they more likely than nonethicists to act according to values they espouse, according to researchers from the ...
Psychology & Psychiatry 10 hours ago | 5 / 5 (1) | 0
(HealthDay)—For HIV-infected individuals with recurrent Clostridium difficile infection, fecal microbiota therapy is feasible, according to a letter published in the May 21 issue of the Annals of Intern ...
20 minutes ago | not rated yet | 0
(AP)—A federal panel of medical experts says that an experimental insomnia drug from Merck & Co Inc. appears safe and effective, despite evidence from company trials that the pill can cause daytime sleepiness and difficulty ...
31 minutes ago | not rated yet | 0
(HealthDay)—Implementation of systematic monitoring for medication adherence will allow for identification of barriers to adherence and tailoring of interventions, according to a viewpoint piece published ...
1 hour ago | not rated yet | 0
(HealthDay)—Migraines and depression can each cause a great deal of suffering, but new research indicates the combination of the two may be linked to something else entirely—a smaller brain.
2 hours ago | 5 / 5 (1) | 0 |
As the world prepares for what may be the next pandemic strain of influenza virus, in the H7N9 bird flu, a new UC Irvine study reveals that the 2009 H1N1 swine flu pandemic was deadliest for people under the age of 65, while ...
1 hour ago | not rated yet | 0