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Antidepressants may be best add-on to antipsychotics in schizophrenia

Key clinical point: Patients with schizophrenia on antipsychotics who need adjunctive treatment might benefit from more antidepressant and less benzodiazepine use.

Major finding: Compared with patients who went on another antipsychotic, those who took an antidepressant had a lower risk of psychiatric hospitalization (hazard ratio, 0.84; 95% confidence interval, 0.80-0.88) and psychiatric emergency room visits (HR, 0.92; 95% CI, 0.88-0.96).

Study details: Retrospective analysis of 81,921 adult outpatients on Medicaid with schizophrenia from 2001-2010, tracked for up to 1 year from initiation of medication beyond initial antipsychotic.

Disclosures: The study authors report various relationships with drugmakers, including Auspex, Intra-Cellular Therapies, Eli Lilly, Bristol-Myers Squibb, Merck, and others. The study was funded by a Patient-Centered Outcomes Research Institute award.

Citation:

Stroup TS et al. JAMA Psychiatry. 2019 Feb 20. doi: 10.1001/jamapsychiatry.2018.4489.

Commentary:

Much of the research into adjunctive therapy in schizophrenia is of poor quality, and other hurdles make it difficult to understand the best treatment approach. The new study links the addition of an antidepressant to a substantial lowering of psychiatric hospitalization risk, compared with initiating another antipsychotic, wrote Donald C. Goff, MD. Previous randomized controlled trials (RCTs) have suggested that adding on antidepressants can moderately reduce symptoms – mainly negative ones – in schizophrenia. The study findings are preliminary and suggest that an RCT is in order.

Dr. Goff disclosed grants from Avanir.

These statements are based on an accompanying editorial by Dr. Goff of New York University (JAMA Psychiatry. 2019 Feb 20. doi: 10.1001/jamapsychiatry.2018.4318).

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Family Involvement in Veterans with Schizophrenia, Psychiatr Rehabil J; ePub 2019 Mar 28; Cohen, et al

Cognitive Training Program in Schizophrenia, Schizophr Res; ePub 2019 Mar 28; Mahncke, et al

Continuous Exercise & CI in Schizophrenia, Front Psychiatry; ePub 2019 Mar 13; Herbsleb, et al

MHC Risk Variants in Cortical Thickness, Brain Behav; ePub 2019 Mar 28; Tao, et al

Disclosing the Diagnosis of Schizophrenia, Int J Soc Psychiatry; ePub 2019 Mar 27; Setti, et al