Antidepressant use common in schizophrenia patients
MedWire News: Around 40% of patients with schizophrenia have been prescribed an antidepressant medication, despite a lack of evidence supporting their effectiveness in this patient group, say researchers.
"Using antidepressant medication to treat major depression or primary negative symptoms associated with schizophrenia remains controversial," explain Seth Himelhoch and colleagues, from the University of Maryland School of Medicine in Baltimore, USA.
"Two recent meta-analyses have questioned the efficacy of antidepressant treatment targeting depression among those with schizophrenia… [and] some but not all meta-analyses have questioned the efficacy of antidepressants to treat primary negative symptoms," they add.
For the current study, the researchers used data from the Veterans Affairs (VA) Capitol Health Care Network (mid-Atlantic region) for the fiscal year 2007 to investigate antidepressant prescribing patterns among 2412 veterans diagnosed with schizophrenia.
Among the patients, 22.2% had a co-occurring depressive disorder, 12.4% had a co-occurring diagnosis of post-traumatic stress disorder (PTSD), 25.4% had a co-occurring substance abuse disorder, and 6.3% had a co-occurring diagnosis of anxiety disorder.
Overall, 37.4% (n=902) of the schizophrenia patients received an antidepressant prescription in 2007. Of these, 77.8% were prescribed one, 20.8% were prescribed two, and 1.4% were prescribed three antidepressant medications at any time during the study period.
Regarding antidepressant medication types, 84.5% of patients were prescribed a selective serotonin reuptake inhibitor or a selective norepinephrine reuptake inhibitor, 22.9% were prescribed a tricyclic or tetracyclic, and 16.1% were prescribed other types of antidepressant.
Multivariable logistic regression analysis revealed that factors significantly associated with receipt of an antidepressant prescription included any visit to a specialty mental health clinic (odds ratio [OR]=4.45), co-occurring depression (OR=3.40), co-occurring PTSD (OR=2.17), and a co-occurring substance use disorder (OR=1.36).
Veterans with a history of homelessness were significantly less likely to be prescribed antidepressants than those without such a history (OR=0.66).
Himelhoch and team conclude in Schizophrenia Research: "Approximately four out of ten veterans receiving treatment for schizophrenia in the mid-Atlantic VA health care service region received a prescription of an antidepressant in fiscal year 2007."
They add: "Further studies are needed to examine the reasons why clinicians prescribe antidepressant medications to persons with schizophrenia and whether the benefits associated with antidepressant use outweigh their health risks."
By Mark Cowen