Treatment of post-psychotic depression in first-episode psychosis. A systematic review

Abstract

Background

Post-psychotic depression (PPD) after a FEP (first-episode psychosis) differs from other depressive symptoms in chronic schizophrenia in its aetiology, symptomatology, and prognostic implications. The objective was to search if any pharmacological or non-pharmacological interventions have proven to be effective on depressive symptoms after a FEP.

Methods

for this systematic review we systematically searched and screened PubMed for articles published from August 1975 to October 15, 2020, with the terms: treatment AND first-episode psychosis OR post-psychotic OR post-schizophrenic AND depression.

Results

we identified 139 articles of which 20 met the inclusion criteria. These interventions were then categorized into four subgroups (antipsychotics, antidepressants, psychological and miscellaneous)

Limitations

this review has several limitations. The reviewed studies were heterogeneous as to assessments, interventions, and samples; furthermore, only one study had PPD in FEP as its primary outcome.

Conclusions

to our knowledge, this is the first review of PPD in a FEP’s treatment. PPD continues to be a diagnostic and therapeutic challenge. The available evidence for the use of treatment whether pharmacological or non-pharmacological is limited. However, certain approaches such as online therapy and treatment with n-3 polyunsaturated fatty acids (PUFA) show promising results. It could be of interest for future studies to focus not only on the treatment of PPD but also on the diagnostic heterogeneity of the sample and the adaptation of the content of the intervention to the individual.

Keywords:

• Depression
• schizophrenia
• antipsychotics
• antidepressants
• post psychotic

Disclosure statement

Luis Gutiérrez-Rojas has been speaker for and advisory board member of Novartis, Janssen-Cilag, Astra-Zeneca, Lundbeck, Otsuka, GSK and Pfizer. All other researchers report no biomedical financial interests or potential conflicts of interests.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Notes on contributors

Isabel Bodoano Sánchez

Isabel Bodoano Sánchez M.D., is a fourth-year psychiatry resident in the Hospital Virgen de las Nieves. She graduated with honours from Cantabria University with a degree in medicine. During her residency she has combined the studies and her work in clinical medicine with investigation. She has a particular interest in psychosis.

Alba Mata Agudo

Alba Mata Agudo M.D., is currently a Psychiatry fourth year intern in Hospital Virgen de las Nieves. She studied Medicine in Unviersitat de Girona and also the Nursing degree in Universitat de Barcelona. She received an expert's degree in Contextual behaviour therapies from la Universidad de Almería and an expert's degree in Personality disorders from AEFDP.

Margarita Guerrero-Jiménez

Margarita Guerrero-Jiménez M.D., Ph.D., is a Psychiatrist. She is currently working as a psychiatrist specialist in the Hospital Virgen de las Nieves. She has made four university degrees from the University of Alcalá de Henares in Mental Health Emergencies and Affective Disorders, University of Granada in Neuroscience and Pain, International University of Valencia in Third Generation Psychotherapies and University of La Rioja in Sanitary Management and Direction.

Braulio Girela Serrano

Braulio Girela-Serrano M.D., is a Speciality Doctor in Child and Adolescent Psychiatry (Central and North West London NHS Foundation Trust) and Honorary Clinical Research Fellow at the Imperial College London (Department of Brain Sciences, Division of Psychiatry).

Paula Álvarez Gil

Paula Álvarez Gil M.D., is currently a Psychiatry third year intern in Hospital Virgen de las Nieves in Granada.

Carmen Maura Carrillo de Albornoz Calahorro

Carmen Maura Carrillo M.D., Ph. D., after graduating in Medicine, she completed two clinical residencies, Family Medicine and subsequently Psychiatry. She completed her doctoral thesis on Epidemiology of Paranoia within the research group Bioenvironmental Psychiatry. She is currently working as a psychiatrist at Hospital Virgen de las Nieves and is an invited professor in the Department of Psychiatry at the University of Granada.

Luis Gutiérrez-Rojas

Luis Gutiérrez-Rojas M.D., Ph.D., is a Psychiatrist and Associate Professor of Psychiatry and Medical Psychology at the University of Granada. He is working at the University Hospital San Cecilio in Granada and is currently focused on undergraduate/postgraduate teaching and research. His latest publications are available at: ORCID: https://orcid.org/0000-0003-0082-2189.