Treatment of negative schizophrenic symptoms with antidepressants

Due to similarity and association of depression with negative symptoms of schizophrenia, many doctors prescribe anti-depressants to patients with negative schizophrenic symptoms. 

According to meta-analysis published in British Journal of Psychiatry (Efficacy of anti-depressants in treating the negative symptoms of chronic schizophrenia: Meta-analysis by Surendra p. Singh, Vidhi Sinh, Nilamadhab Kar and Kelvin Chan) there is a good reason to believe that above practice has good evidence base.

 

Above meta-analysis went through 22 randomized placebo controlled clinical trials. It found that there is a statistically significant symptom relief when anti-depressants were co - prescribed with antipsychotics for negative schizophrenic symptoms. 

What are the common negative schizophrenic symptoms?

• Social withdrawal

• Underactivity

• Lack of speech

• Slowness

• Depression

• Lack of drive

• Apathy

Above symptoms are the most common symptoms seen in negative schizophrenia. They are very difficult to treat. Co prescribing Antidepressants are found to be effective in treating negative schizophrenia.  

Individual antidepressants that are found to be effective in treating negative symptoms

It seems Ritanserin and Trazadone is more effective in treating negative schizophrenic symptoms. Ritanserin > Trazadone > Fluoxetine

Ritanserin is the generic name of Tisterton. Trazadone is generic name of Desyrel. Fluoxetine is the generic of Prozac. Fluoxetine had minimal effects in treating negative schizophrenia. 

Limitations of above meta-analysis

• Numbers of trials are relatively small. 

• Number of trials are not adequate in interpreting individual anti-depressant effects.

• Three studies with very large effect size shift whole study to that direction

• No RCTs available for tricyclics, venlafaxine, and mono amine oxidase inhibitors. 

Sources

1. Efficacy of anti-depressants in treating the negative symptoms of chronic schizophrenia: Meta-analysis by Surendra p. Singh, Vidhi Sinh, Nilamadhab Kar and Kelvin Chan

Complications of Newer Antipsychotic drugs

Newer anti-psychotics gave hope for the psychiatry patients due to their low side effects profile. Commonly used newer antipsychotic drugs are Zyprexa, Clozaril, Risperdal and Abilify. They cause fewer extra-pyramidal side effects compared to older typical anti-psychotics. In addition, serious complications such as neuroleptic malignant syndrome and tardive dyskinesia are rare in newer anti psychotics (compared to older anti psychotics).

But recent evidence suggest that newer anti psychotics have different very dangerous complications. Newer atypical anti psychotics are known to cause serious blood lipid elevation in certain patients. It can complicate ischemic heart disease treatment in such patients. In addition, atypical/newer anti psychotics increase body weight. Common drugs that are responsible for body weight increase are Zyprexa, Clozaril and Seroquel. Risperdal and Abilify cause less weight gain. In fact Abilify seems to cause weight reduction in certain individuals.

Newer atypical antipsychotics such as Zyprexa, Clozaril and Risperdal (less) can also cause diabetes mellitus by way of increasing blood glucose level.

Therefore, long term overall benefit of newer anti psychotics remain questionable.

Can depression cause heart problems

According to a recent study published in Psychophysiology ( Volume 48, Issue 11, pages 1605–1610, November 2011) there seems to be  a statistically significant relationship between DSM IV Major depressive disorder and cardiovascular recovery after exercise.

There were numerous studies done to determine relationship between heart problems and depression. According to (Barth, Schumacher, & Herrmann-Lingen, 2004; Carney et al., 2008; Lavoie & Fleet, 2000; Lesperance, Frasure-Smith, Talajic, & Bourassa, 2002; Rozanski, Blumenthal, & Kaplan, 1999; Rutledge et al., 2006) Major depressive disorder is associated with heart problems. In fact, heart diseases can be caused by Major depression  as well as existing heart problems can be aggravated by major depressive disorder.

During vigorous exercises our heart rate increases exponentially. But immediately after physical exercise, heart rate becomes normal within a short period of time. But people with a dysfunctional autonomic nervous system have delayed heart rate recovery after exercise. This delayed recovery is linked to heart diseases by several studies (Cole, Blackstone, Pashkow, Snader, & Lauer, 1999; Jouven et al., 2005; Mora et al., 2003; Nishime, Cole, Blackstone, Pashkow, & Lauer, 2000).

According to the above “The effect of major depression on post exercise cardiovascular recovery” study researcher’s found a statistically significant delay in recovery of heart rate following exercise by way of stress testing (treadmill). Therefore, there can be a autonomic nervous system dysfunction in Major depressive disorder. 

In addition to the biological vulnerability for heart disease, people with major depression have many life style issues that is detrimental to the heart such as lack of exercises and bad food habits.

Depression increases risk of heart disease

Most people with depression do not care about the healthy food choices, because of lack of energy and motivation. In addition, they do not do regular exercises again due to lack of energy. In addition, depressed people with diabetes or ischemic heart disease tend to miss their pills.

Diabetic patients with depression tend to forget monitoring their health and take medications

Depressed people tend to ignore healthy food choices

Depressed people tend to do less exercise

Conclusion

Major depression is associated with significant heart problems. It is due to both life style issues such as lack of exercises seen in major depression as well due to biochemical and physiological abnormalities seen in depression.

Therefore, it is very important to treat depression in people with cardiovascular risk. 

Sources

The effect of major depression on post exercise cardiovascular recovery