Randomized Controlled Trials of Add-On Antidepressants in Schizophrenia

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http://hdl.handle.net/10138/225091

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Terevnikov , V , Joffe , G & Stenberg , J-H 2015 , ' Randomized Controlled Trials of Add-On Antidepressants in Schizophrenia ' , International Journal of Neuropsychopharmacology , vol. 18 , no. 9 . https://doi.org/10.1093/ijnp/pyv049

Title: Randomized Controlled Trials of Add-On Antidepressants in Schizophrenia
Author: Terevnikov, Viacheslav; Joffe, Grigori; Stenberg, Jan-Henry
Contributor: University of Helsinki, Clinicum
University of Helsinki, Department of Psychiatry
University of Helsinki, Clinicum
Date: 2015-07
Language: eng
Number of pages: 14
Belongs to series: International Journal of Neuropsychopharmacology
ISSN: 1461-1457
URI: http://hdl.handle.net/10138/225091
Abstract: Background: Despite adequate treatment with antipsychotics, a substantial number of patients with schizophrenia demonstrate only suboptimal clinical outcome. To overcome this challenge, various psychopharmacological combination strategies have been used, including antidepressants added to antipsychotics. Methods: To analyze the efficacy of add-on antidepressants for the treatment of negative, positive, cognitive, depressive, and antipsychotic-induced extrapyramidal symptoms in schizophrenia, published randomized controlled trials assessing the efficacy of adjunctive antidepressants in schizophrenia were reviewed using the following parameters: baseline clinical characteristics and number of patients, their on-going antipsychotic treatment, dosage of the add-on antidepressants, duration of the trial, efficacy measures, and outcomes. Results: There were 36 randomized controlled trials reported in 41 journal publications (n = 1582). The antidepressants used were the selective serotonin reuptake inhibitors, duloxetine, imipramine, mianserin, mirtazapine, nefazodone, reboxetin, trazodone, and bupropion. Mirtazapine and mianserin showed somewhat consistent efficacy for negative symptoms and both seemed to enhance neurocognition. Trazodone and nefazodone appeared to improve the antipsychotics-induced extrapyramidal symptoms. Imipramine and duloxetine tended to improve depressive symptoms. No clear evidence supporting selective serotonin reuptake inhibitors' efficacy on any clinical domain of schizophrenia was found. Add-on antidepressants did not worsen psychosis. Conclusions: Despite a substantial number of randomized controlled trials, the overall efficacy of add-on antidepressants in schizophrenia remains uncertain mainly due to methodological issues. Some differences in efficacy on several schizophrenia domains seem, however, to exist and to vary by the antidepressant subgroups-plausibly due to differences in the mechanisms of action. Antidepressants may not worsen the course of psychosis. Better designed, larger, and longer randomized controlled trials are needed.
Subject: antidepressants
antipsychotics
schizophrenia
add-on treatment
PLACEBO-CONTROLLED TRIAL
TREATMENT-RESISTANT SCHIZOPHRENIA
ATYPICAL ANTIPSYCHOTIC-DRUGS
BUPROPION SUSTAINED-RELEASE
IMPROVES NEGATIVE SYMPTOMS
INDUCED WEIGHT-GAIN
DOUBLE-BLIND TRIAL
MIRTAZAPINE ADD
ADJUNCTIVE TREATMENT
COGNITIVE FUNCTION
3124 Neurology and psychiatry
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