Escitalopram add-on in stable Schizophrenia with subsyndromal depression
DOI:
https://doi.org/10.18203/2349-3933.ijam20196076Keywords:
Escitalopram, Schizophrenia, Subsyndromal depressionAbstract
Background: Significant proportion of the patients of schizophrenia suffer from subsyndromal symptomatic depressive symptoms (SSD) which not only add to the burden of disease but also to the already pre-existing challenges of living with this serious mental illness. Many psychiatrists prescribe antidepressants to patients with schizophrenia who have subsyndromal symptomatic depressive symptoms but data regarding SSD in schizophrenia is meagre. Aim was to study the effect of addition of Escitalopram on psychopathology, cognition and functioning in patients with stable schizophrenia having subsyndromal depressive symptoms and to compare these parameters with patients treated with antipsychotics alone.
Methods: The study was a prospective, 8-week randomized double-blind placebo-controlled trial. Seventy four patients who fulfilled the diagnostic criteria of Schizophrenia on the basis of the ICD10-DCR, adjudged to be stable clinically and not requiring any increase in dose of antipsychotic medication over the last eight weeks were recruited into the study. The patients randomly received either Antipsychotics with add-on Escitalopram (10 mg/day) or Antipsychotics with placebo for 8 weeks. The patients were assessed using the HAM-D, CDRS, PANSS, SCoRS, SOFAS and CGI scores at the end of 8 weeks. Patients were also assessed for adverse events at baseline, week 4 and week 8.
Results: A total of sixty-six patients who completed the study were analyzed. The HAM-D, CDRS and PANSS score showed significantly better cognition and functioning in the patients of add-on Escitalopram group when compared with the placebo group. There was no significant difference between the two groups in terms of observed side effects.
Conclusions: Escitalopram addition to the standard anti-psychotic treatment of schizophrenia, in patients having subsyndromal depressive symptoms, results in better cognition and improved functioning.
References
Frith CD, Blakemore S-J, Wolpert DM. Explaining the symptoms of schizophrenia: abnormalities in the awareness of action. Brain Res Rev. 2000;31(2-3):357-63.
Bartels SJ, Drake RE. Depressive symptoms in schizophrenia: comprehensive differential diagnosis. Comprehensive Psychiatry. 1988;29(5):467-83.
Zisook S, Nyer M, Kasckow J, Golshan S, Lehman D, Montross L. Depressive symptom patterns in patients with chronic schizophrenia and subsyndromal depression. Schizophrenia Res. 2006;86(1):226-33.
Siris SG. Depression in schizophrenia. In: Shriqui CL, Nasrallah HA, Eds. Contemporary Issues in the Treatment of Schizophrenia. Washington, DC: American Psychiatric Association; 1995;155-166.
Jin H, Zisook S, Palmer BW, Patterson TL, Heaton RK, Jeste DV. Association of depressive symptoms with worse functioning in schizophrenia: a study in older outpatients. J Clini Psychiatr. 2001;62(10):797-803.
Siris SG. Suicide and schizophrenia. J Psychopharmacol. 2001;15(2):127-35.
Cohen CI. Studies of the course and outcome of schizophrenia in later life. Psychiatric services (Washington, DC). 1995;46(9):877-9,89.
Zisook S, Kasckow JW, Golshan S, Fellows I, Solorzano E, Lehman D, et al. Citalopram augmentation for subsyndromal symptoms of depression in middle-aged and older outpatients with schizophrenia and schizoaffective disorder: a randomized controlled trial. J Clini Psychiatr. 2009;70(4):562-71.
Sands JR, Harrow M. Depression during the longitudinal course of schizophrenia. Schizophrenia Bulletin. 1999;25(1):157.
Broadhead WE, Blazer DG, George LK, Tse CK. Depression, disability days, and days lost from work in a prospective epidemiologic survey. JAMA. 1990;264(19):2524-8.
Omranifard V, Hosseini GM, Sharbafchi MR, Maracy M, Ghasemi F, Aminoroaia M. Sertraline as an add-on treatment for depression symptoms in stable schizophrenia: A double-blind randomized controlled trial. J Res Med Sci. 2012;17.
Siris SG, Van Kammen DP, Docherty JP. Use of antidepressant drugs in schizophrenia. Arch Gen Psychiatry. 1978;35:1368.
Spina E, De Domenico P, Ruello C, Longobardo N, Gitto C, Ancione M, et al. Adjunctive fluoxetine in the treatment of negative symptoms in chronic schizophrenic patients. Int Clin Psychopharmacol. 1994;9:281-5.
Mulholland C, Lynch G, King DJ. Sertraline for depressive symptoms in patients with stable, chronic schizophrenia: a double-blind placebo-controlled study. J Psychopharmacol. 2003;17(1):107-12.
Zisook S, Kasckow JW. Citalopram augmentation for subsyndromal symptoms of depression in middle-aged and older outpatients with schizophrenia and schizoaffective disorder: a randomized controlled trial. J Clin Psychiatr. 2009;70:562-71.
Poyurovsky M, Koren D, Gonopolsky I, Schneidman M, Fuchs C, Weizman A, et al. Effect of the 5-HT2 antagonist mianserin on cognitive dysfunction in chronic schizophrenia patients: an add-on, double-blind placebo-controlled. Eur Neuropsychopharmacol. 2003;13:123-8.
Mico U, Bruno A, Pandolfo G, Maria Romeo V, Mallamace D, D’Arrigo C, et al. Duloxetine as adjunctive treatment to clozapine in patients with schizophrenia: a randomized, placebo-controlled trial. Int Clin Psychopharmacol. 2011;26:303-10.
Terevnikov V, Stenberg JH, Tiihonen J, Joffe M, Burkin M, Tchoukhine E, et al. Add-on mirtazapine improves depressive symptoms in schizophrenia: a double-blind randomized placebo-controlled study with an open-label extension phase. Hum Psychopharmacol Clin. 2011;26:188-93.
Salokangas RKR, Saarijarvi S, Taiminen T, Kallioniemi H, Lehto H, Niemi H, et al. Citalopram as an adjuvant in chronic schizophrenia: a double-blind placebo-controlled study. Acta Psychiatr Scand. 1996;94:175-80.
Leucht S, Engel RR. The relative sensitivity of the Clinical Global Impressions Scale and the Brief Psychiatric Rating Scale in antipsychotic drug trials. Neuropsychopharmacol. 2006;31(2):406-12,253.