May selective serotonin reuptake inhibitors (SSRIs) provide some benefit for the treatment of schizophrenia?

ABSTRACT

Introduction: The treatment of some psychopathological dimensions of schizophrenia (e.g. negative and depressive symptoms) is still challenging for the modest efficacy of atypical antipsychotics. Among pharmacological alternatives, augmentative Selective Serotonin Reuptake Inhibitors (SSRIs) to antipsychotics are frequently prescribed in clinical practice to improve negative/depressive symptoms of schizophrenia patients; however, the data about the efficacy of these molecules on negative, depressive and obsessive-compulsive symptoms of schizophrenia are contrasting.

Areas Covered: Research using the main database sources has been conducted to obtain an overview of the use and efficacy of SSRIs in schizophrenia.

Expert Opinion: Data are too scanty to draw definitive recommendations. In a preliminary way, it can be said that available data do not show effectiveness of SSRIs on depressive symptoms of schizophrenia. Regarding negative symptoms, studies are contrasting, but paroxetine appears to be the most effective compound among SSRIs. Despite limited data, SSRIs appear to be useful for the treatment of obsessive-compulsive symptoms of schizophrenia, particularly fluvoxamine. Close clinical and pharmacological monitoring is needed in case of concomitant administration of antipsychotics and antidepressants for potential serious side effects and influence on plasma drug dosages

KEYWORDS:

• Selective Serotonin Reuptake Inhibitors (SSRIs)
• schizophrenia
• negative symptoms
• depression
• obsessive-compulsive symptoms

Article highlights

• Atypical antipsychotics have a modest effect on negative and depressive symptoms of schizophrenia

• Antidepressants, including SSRIs, are prescribed for the treatment of negative, depressive, obsessive-compulsive symptoms of schizophrenia, despite the current contrasting data about their efficacy

• Studies with small samples and the potential dangerous sides effects of antipsychotic/SSRI combination prevent from recommending the use of SSRIs for schizophrenia treatment

• Available data indicate that SSRIs have no effect on depressive symptoms of schizophrenia, but most studies are underpowered

• SSRIs have a doubtful effect on negative symptoms of schizophrenia: paroxetine might be more effective than other compounds, but currently head-to-head double-blind trials are lacking

• Fluvoxamine might be useful for the treatment of obsessive-compulsive symptoms, but data with other SSRIs are scanty and the positive data have to be replicated by further double-blind controlled studies and meta-analytical approaches

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Declaration of interests

AC Altamura has served as a consultant or on Advisory Boards for Roche, Merck, Astra Zeneca, Bristol-Myers Squibb, Janssen/Cilag and Lundbeck. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.