Antidepressant and Antipsychotic Polypharmacy: New Data

Peter M. Yellowlees, MBBS, MD


October 26, 2016

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This is the Medscape Psychiatry Minute. I'm Dr Peter Yellowlees. Schizophrenia is commonly associated with both depressive and negative symptoms, and it has long been common practice for psychiatrists to use antidepressants as an adjunctive treatment to antipsychotics for either set of symptoms. Now, a team of investigators[1] from Munich, Germany, has examined the safety and efficacy of antidepressants added to antipsychotic drugs for the treatment of schizophrenia. Eighty-two randomized controlled trials with a total of 3608 participants were included. The authors' analysis of primary outcomes (ie, depressive and negative symptoms) suggested small, beneficial effects of adjunctive antidepressants overall. They concluded that this augmentation can be accomplished with a low risk for exacerbation of psychosis and adverse effects—although, not surprisingly, patients taking add-on antidepressants suffered more side effects, such as abdominal pain, constipation, dizziness, and dry mouth.

This is an interesting study that supports a longstanding clinical practice and provides evidence for both the efficacy and safety of antidepressants added to antipsychotics for patients with schizophrenia who have depressive or negative symptoms. Any treatment that can improve the quality of life of individuals with schizophrenia is important, and this approach is certainly something that should be considered when clinically appropriate.

Thank you for listening to this Medscape Psychiatry Minute. Do enjoy your practice.


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