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Treatments for depressive symptoms

What is depression?

Depression is characterised by a depressed mood and/or a loss of interest or pleasure in activities. Symptoms of depression include changes in appetite, weight, sleep, and psychomotor activity, decreased energy, blunted affect, social withdrawal, difficulty concentrating or making decisions, feelings of worthlessness, hopelessness and guilt, and thoughts of suicide. As many symptoms are common to both depression and the negative syndrome of schizophrenia it can be difficult to identify a comorbid depressive illness in people with schizophrenia. Identifying and treating a comorbid depressive illness may increase the likelihood of recovery from psychosis and reduce the likelihood of psychotic relapse.

What is the evidence for pharmaceutical treatments for depression in people with schizophrenia?

For adjunctive antidepressants compared to placebo or no adjunctive treatment, moderate quality evidence finds a small effect of greater improvement in depressive symptoms with adjunctive antidepressants.

For antipsychotics alone compared to placebo, moderate to high quality evidence finds a large effect of greater improvement in depressive symptoms with sulpiride. There were medium-sized improvements with clozapine, amisulpride, and aripiprazole over placebo. There were small improvements with olanzapine, cariprazine, paliperidone, asenapine, quetiapine, risperidone, ziprasidone, lurasidone, haloperidol, and brexpiprazole. There were no improvements over placebo with clopenthixol, sertindole, flupentixol, chlorpromazine, perphenazine, zotepine, zuclopenthixol, thiotixene, loxapine, penfluridol, pimozide, perazine, trifluoperazine, molindone, or levomepromazine.

Moderate to low quality evidence suggests the antipsychotic clozapine may improve depression symptoms more than any other antipsychotic combined with the antidepressants amitryptiline, mianserin, meclobemide or placebo.

October 2020

Last updated at: 3:22 am, 6th October 2020
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Title Colour Legend:
Green - Topic summary is available.
Orange - Topic summary is being compiled.
Red - Topic summary has no current systematic review available.