Pharmacological strategies for the management of comorbid depression and schizophrenia

ABSTRACT

Introduction: Depressive symptoms may occur in any phase of schizophrenia and can have far-reaching consequences.

Areas covered: The author focuses on recent reviews and meta-analyses dealing with the prevalence, importance, etiopathogenesis, and pharmacotherapy of comorbid depression and schizophrenia. Depressive symptoms in acute episodes may improve in parallel with psychosis due to antipsychotic treatment. Therefore, the first step is to evaluate the current antipsychotic treatment of psychotic symptoms and consider changing the dosage. A second step is switching antipsychotic medications, since there are indications that some medications are slightly more effective in reducing depressive symptoms than others. For persistent depressive episodes, additional therapeutic interventions are indicated. Most guidelines recommend the administration of antidepressants as an add-on treatment with a limited evidence level. Immunotherapeutic strategies could be successful, at least in some schizophrenia patients.

Expert opinion: In the near future, precision psychiatry should enable clinicians to recognize specific biotypes with unique biosignatures that will guide accurate and prompt clinical management for individual patients.

KEYWORDS:

• Depression
• schizophrenia
• antipsychotics
• antidepressants
• anti-inflammatory agents
• biomarkers

Article Highlights

• Patients with schizophrenia should be regularly assessed regarding depressive symptoms including suicide risk. Comorbid depression should be aggressively treated.

• FGAs should not be primarily used for the treatment of depressive symptoms in schizophrenia

• There is limited evidence that adding TCAs and other ADs (SSRIs, dual reuptake inhibitors, others) to antipsychotics, especially FGAs may have small beneficial effect in the treatment of comorbid depression and schizophrenia.

• Prospective multicenter comparative trials are clearly needed to investigate the efficacy of individual antidepressants in schizophrenia-associated depression.

• Specific anti-inflammatory drugs appear to be promising strategies in treatment of inflammation related depression in schizophrenia.

This box summarizes key points contained in the article.

Declaration of interest

The author has 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.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was supported by the Ministry of Education, Youth and Sports of the Czech Republic CEITEC 2020 [LQ1601].