Advertisement

Antidepressants in “Depressed” Schizophrenics

  • Samuel G. Siris
Conference paper

Abstract

Schizophrenia is a disorder with many associated morbidities. Objective manifestations of psychopathology, subjective suffering, social and vocational dysfunction, and family burden are all well known and have been well described. Among the heterogeneous patternings of symptoms which may occur in conjunction with schizophrenia are those that have been labeled as “depression” because of their phenotypic resemblance to states of depression occurring in non-schizophrenic populations (1–8). Many schizophrenic patients are found to present with such a condition, involving a pessimistic, underenergized, gloomy, pleasureless, and bedraggled state. In it, their ability to concentrate may be low, their appetitive drives for food and sex may be reduced, their sleep patterns may be altered, and some may even seem to lose their will to live. Although the etiology of this sort of “depression” is not necessarily clear and may well be varied, the fact that these states are in so many ways phenocopies of cases of primary depression raises the logical question as to whether they might be responsive to treatment with antidepressant medications. This is, indeed, a very logical question because “depression” itself is a syndrome which is really a final common clinical path. Thus, even if the initiating etiology is not the same, a treatment useful for one form of depression (such as primary depression) might also benefit patients with another form of depression (such as secondary depression in schizophrenia) by interacting with points on the causal pathway distal to the primary diathesis but still proximal to the clinical expression of the “depression.”

Keywords

Schizophrenic Patient Antidepressant Medication Clinical Global Impression Brief Psychiatric Rate Scale Antiparkinsonian Medication 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    McGlashan TH, Carpenter WT Jr.: Post-psychotic depression in schizophrenia. Arch Gen Psychiatry 33: 231 - 241, 1976.PubMedCrossRefGoogle Scholar
  2. 2.
    Falloon I, Watt DC, Shepherd M: A comparative controlled trial of pimozide and fluphenazine decanoate in the continuation therapy of schizophrenia. Psychol Med 8: 59 - 70, 1978.Google Scholar
  3. 3.
    Knights A, Hirsch SR: ‘Revealed’ depression and drug treatment for schizophrenia. Arch Gen Psychiatry 38: 806 - 811, 1981.PubMedCrossRefGoogle Scholar
  4. 4.
    Johnson DAW: Studies of depressive symptoms in schizophrenia. Br J Psychiatry 139: 89 - 101, 1981.PubMedCrossRefGoogle Scholar
  5. 5.
    Siris SG, Harmon GK, Endicott J: Post-psychotic depressive symptoms in hospitalized schizophrenic patients. Arch Gen Psychiatry 38: 1122 - 1123, 1981.PubMedCrossRefGoogle Scholar
  6. 6.
    Mandel MR, Severe JB, Schooler NR, et al: Development and prediction of post-psychotic depression in neuroleptic-treatment schizophrenics. Arch Gen Psychiatry 39: 197 - 203, 1982.PubMedCrossRefGoogle Scholar
  7. 7.
    Roy A, Thompson R, Kennedy S: Depression in chronic schizophrenia. Br J Psychiatry 142: 465 - 470, 1983.PubMedCrossRefGoogle Scholar
  8. 8.
    Martin RL, Cloninger CR, Guze SB, et al: Frequency and differential diagnosis of depressive syndrome in schizophrenia. J Clin Psychiatry 46 (11 Sec 2): 9 - 13, 1985PubMedGoogle Scholar
  9. 9.
    Rifkin A, Qitkin F, Klein DF: Akinesia: A poorly recognized drug-induced extrapyramidal behavioral disorder. Arch Gen Psychiatry 32: 672 - 674, 1975.CrossRefGoogle Scholar
  10. 10.
    Van Putten T, May PR: “Akinetic depression” in schizophrenia. Arch Gen Psychiatry 35: 1101 - 1107, 1978.PubMedCrossRefGoogle Scholar
  11. 11.
    Siris SG: Akinesia and post-psychotic depression: A difficult differential diagnosis. J Clin Psychiatry 48: 240 - 243, 1987.PubMedGoogle Scholar
  12. 12.
    Chien C, DiMascio A, Cole JO: Antiparkinson agents and depot phenothiazine. Am J Psychiatry 131: 86 - 90, 1974.PubMedGoogle Scholar
  13. 13.
    Rifkin A, Quitkin F, Kane J, et al: Are prophylactic antiparkinson drugs necessary? Arch Gen Psychiatry 35: 483 - 489, 1978.PubMedCrossRefGoogle Scholar
  14. 14.
    Van Putten T: Adverse psychological (or behavioral) responses to antipsychotic drug treatment of schizophrenia, in Schizophrenia and Affective Disorders: Biology and Drug Treatment edited by Rifkin A. Boston, John Wright/PSG, 1983.Google Scholar
  15. 15.
    Siris SG: Pharmacological treatment of depression in schizophrenia, in Depression and Schizophrenia. Edited by Delisi, L. Washington, American Psychological Association, in press.Google Scholar
  16. 16.
    Van Putten T: The many faces of akathisia. Compr Psychiatry 16: 43 - 47, 1975.PubMedCrossRefGoogle Scholar
  17. 17.
    Siris SG: Three cases of akathisia and “acting out.” J Clin Psychiatry 46: 395 - 397, 1985.PubMedGoogle Scholar
  18. 18.
    Siris SG, Rifkin A, Reardon GT, et al: Comparative side effects to imipramine, benztropine, or their combination in patients receiving fluphenazine decanoate. Am J Psychiatry 140: 1069 - 1071, 1983.PubMedGoogle Scholar
  19. 19.
    deAlarcon R, Carney MWP: Severe depressive mood changes following slow-release intramuscular fluphenazine injection. Br Med J 3: 564 - 567, 1969.CrossRefGoogle Scholar
  20. 20.
    Johnson DAW, Malik NA: A double-blind comparison of fluphenazine decanoate and flupenthixol decanoate in the treatment of acute schizophrenia. Acta Psychiatr Scand 51: 257 - 267, 1975.PubMedGoogle Scholar
  21. 21.
    Ayd F: The depot fluphenazines: A reapprisal after 10 years’ clinical experience. Am J Psychiatry 132: 49 1500, 1975.Google Scholar
  22. 22.
    Floru L, Heinrich K, Wittek F: The problem of post-psychotic schizophrenic depressions and their pharmacological induction. Int Pharmacopsychiat 10: 230239, 1975.Google Scholar
  23. 23.
    Singh MM, Kay SR: Dysphoric response to neuroleptictreatment in schizophrenia: Its relationship to autonomic arousal and prognosis. Biol Psychiatry 14: 277 - 294, 1979.PubMedGoogle Scholar
  24. 24.
    Hogarty GE, Schooler N, Ulrich R, et al: Fluphenazine and social therapy in the aftercare of schizophrenic patients. Arch Gen Psychiatry 36: 1283 - 1294, 1979.PubMedCrossRefGoogle Scholar
  25. 25.
    Ananth J, Chadirian A: Drug-induced mood disorder. Int Pharmacopsychiat 15: 58 - 73, 1980.Google Scholar
  26. 26.
    Caldi J, Rieder RO, Silber D, et al: Genetic factors in the response to neuroleptics in schizophrenia: A pharmacogenetic study. Psychol Med 11: 713 - 728, 1981.CrossRefGoogle Scholar
  27. 27.
    Galdi J: The causality of depression in schizophrenia. Br J Psychiatry 142: 621 - 625, 1983.PubMedCrossRefGoogle Scholar
  28. 28.
    Van Putten T, Marder SR: Low dose treatment strategies. J Clin Psychiatry 47(5) Suppl: 12-16, 1986.Google Scholar
  29. 29.
    Gerner RH, Post RM, Bunney WE Jr.: A dopamine mechanism in mania. Am J Psychiatry 133: 1177 - 1180, 1976.PubMedGoogle Scholar
  30. 30.
    Post RM: Biochemical changes during the switch processes. In Bunney WE Jr (moderator): The switch process in manic-depressive psychosis. Ann Intern Med 87: 319 - 335, 1977.Google Scholar
  31. 31.
    Wise RA: Brain dopamine and reward, in Progress in Psychopharmacology. Edited by Cooper SJ. New York, Academic Press, 1981.Google Scholar
  32. 32.
    Hirsch SR: Depression ‘revealed’ in schizophrenia. Br J Psychiatry 140: 421 - 424, 1982.PubMedCrossRefGoogle Scholar
  33. 33.
    Siris SG, Sellew AP, Frechen K, et al: Antidepressants in the treatment of post-psychotic depression in schizophrenia: Drug interactions and other considerations. J Clin Chem 34: 837 - 840, 1988.Google Scholar
  34. 34.
    Klein DF: Importance of psychiatric diagnosis in prediction of clinical drug effects. Arch Gen Psychiatry 16: 118 - 126, 1967.PubMedCrossRefGoogle Scholar
  35. 35.
    Nelson JC, Bowers MB: Delusional unipolar depression: Description and drug response. Arch Gen Psychiatry 35: 1321 - 1328, 1978.PubMedCrossRefGoogle Scholar
  36. 36.
    Klein DF, Gittleman R, Quitkin F, Rifkin A: Diagnosis and Drug Treatment of Psychiatric Disorders: Adults and Children, Second Edition. Baltimore, Williams & Wilkins, 1980.Google Scholar
  37. 37.
    Charney DS, Nelson JC: Delusional and non-delusional unipolar depression: Further evidence for distinct subtypes. Am J Psychiatry 138: 328 - 333, 1981.PubMedGoogle Scholar
  38. 38.
    Brown RP, Francis A, Koscis JH, et al: Psychotic vs. non-psychotic depression: Comparison of treatment response. J Nery Ment Dis 170: 635 - 637, 1982.CrossRefGoogle Scholar
  39. 39.
    Spiker DG, Weiss JC, Dealy RS, et al: The pharmacological treatment of delusional depression. Am J Psychiatry 142: 430 - 436, 1985.PubMedGoogle Scholar
  40. 40.
    Frank JD: Persuasion and Healing. Baltimore, Johns Hopkins University Press, 1973.Google Scholar
  41. 41.
    Docherty JP, vanKammen DP, Siris SG, et al: Stages of onset of acute schizophrenic psychosis. Am J Psychiatry 135: 420 - 426, 1978.PubMedGoogle Scholar
  42. 42.
    Herz MI, Melville C: Relapse in schizophrenia. Am J Psychiatry 137: 801 - 805, 1980.PubMedGoogle Scholar
  43. 43.
    Siris SG, Rifkin A, Reardon GT, et al: Stability of the post-psychotic depression syndrome. J Clin Psychiatry 47: 86 - 88, 1986.PubMedGoogle Scholar
  44. 44.
    Siris SG, vanKammen DP, Docherty JP: The use of antidepressant medication in schizophrenia: A review of the literature. Arch Gen Psychiatry 35: 1368 - 1377, 1978.PubMedCrossRefGoogle Scholar
  45. 45.
    Michaux MH, Kurland AA, Agallianos DD: Chlorpromazinechlordiazepoxide and chlorpromazine-imipramine treatment of newly hospitalized, acutely ill psychiatric patients. Curr Ther Res 8: 117 - 152, 1966.PubMedGoogle Scholar
  46. 46.
    Hanlon TE, Ota KY, Kurland AA: Comparative effects of fluphenazine, fluphenazine-chlordiazepoxide, and fluphenazine-imipramine. Dis Nerv Syst 31: 171 - 177, 1970.PubMedGoogle Scholar
  47. 47.
    Pishkin V: Concept identification and psychophysiological parameters in depressed schizophrenics as functions of imipramine and nialamide. J Clin Psychol 28: 335 - 339, 1972.PubMedCrossRefGoogle Scholar
  48. 48.
    Kurland AA, Hanlon TE, Ota KY: Combinations of psychotherapeutic drugs in the treatment of the acutely disturbed psychiatric patient, in Advances in Neuropsychopharmacoloay. Edited by Vinar O, Votava Z, Bradley PB. Amsterdam, North-Holland Publishing Co, 1971.Google Scholar
  49. 49.
    Hedberg DL, Houck JH, Glueck BC Jr.: Tranylcyprominetrifluoperazine combination in the treatment of schizophrenia. Am J Psychiatry 127: 1141 - 1146, 1971.PubMedGoogle Scholar
  50. 50.
    Chouinard G, Annable L, Serrano M, et al: Amitriptyline-perphenazine interaction in ambulatory schizophrenic patients. Arch Gen Psychiatry 32: 1295 1307, 1975.Google Scholar
  51. 51.
    Waehrens J, Gerlach J: Antidepressant drugs in anergic schizophrenia: A double-blind cross-over study with maprotiline and placebo. Acta Psychiatr Scand 61: 438444, 1980.Google Scholar
  52. 52.
    Overall J, Gorham D: The brief psychiatric rating scale. Psychol Rep 10: 799 - 812, 1962.CrossRefGoogle Scholar
  53. 53.
    Venables P: A short scale for rating “activity-withdrawal” in schizophrenia. J Ment Sci 103: 197 - 199, 1957.PubMedGoogle Scholar
  54. 54.
    Honigfeld G, Klett SJ: The nurses observation scale for inpatient evaluation. A new scale for measuring improvement in chronic schizophrenia. J Clin Psychol 21: 65 - 71, 1965.PubMedCrossRefGoogle Scholar
  55. 55.
    Kurland AA, Nagaraju A: Viloxazine and the depressed schizophrenic - Methodological issues. J Clin Pharmacol 21: 37 - 41, 1981.PubMedCrossRefGoogle Scholar
  56. 56.
    Hamilton M: A rating scale for depression. J Neurol Neurosurg Psychiatry 23: 56 - 62, 1960.PubMedCrossRefGoogle Scholar
  57. 57.
    Guy W: ECDEU Assessment Manual, CDHEW Publication No. 76-338, 1976.Google Scholar
  58. 58.
    Zung WWK: A self-rating depression scale. Arch Gen Psychiatry 12: 63 - 70, 1965.PubMedCrossRefGoogle Scholar
  59. 59.
    Beck AT, Ward CH, Mendelson M, et al: An inventory for measuring depression. Arch Gen Psychiatry 4: 561 - 571, 1961.PubMedCrossRefGoogle Scholar
  60. 60.
    Asberg M, Cronholm B, Sjoqvist F, et al: Relationship between plasma level and therapeutic effect of nortriptyline. Br Med J 3: 331 - 334, 1971.PubMedCrossRefGoogle Scholar
  61. 61.
    Kragh-Sorensen P, Asberg M, Hansen C: Plasma nortriptyline levels in endogenous depression. Lancet 1: 113 - 115, 1973.PubMedCrossRefGoogle Scholar
  62. 62.
    Kragh-Sorensen P, Hansen C, Baastrup P, et al: Self-inhibiting action of nortriptyline’s antidepressive effect at high plasma levels. Psychopharmacologia 45: 305 - 312, 1976.PubMedCrossRefGoogle Scholar
  63. 63.
    Zeigler V, Clayton P, Taylor J, et al: Nortriptyline plasma levels and therapeutic response. Clin Pharmacol Ther 20: 458 - 563, 1976.Google Scholar
  64. 64.
    Vandel B, Vandel S, Allers G, et al: Interaction between amitriptyline and phenothiazine in man: Effect on plasma concentration of amitriptyline and its metabolite nortriptyline and the correlation with clinical response. Psychopharmacology (Berlin) 65: 187190, 1979.Google Scholar
  65. 65.
    Kragh-Sorensen P, Borga G, Carle L, et al: Effect of simultaneous treatment with low doses of perphenazine on plasma and urine concentrations of nortriptyline and 10hydroxynortriptyline. Eur J Clin Pharmacol 11: 479 - 483, 1977.PubMedCrossRefGoogle Scholar
  66. 66.
    Nelson JC, Jatlow PI: Neuroleptic effect on desipramine steady state plasma concentrations. Am J Psychiatry 137: 1232 - 1234, 1980.PubMedGoogle Scholar
  67. 67.
    Siris SG, Cooper TB, Rifkin A, et al: Plasma imipramine concentrations in patients receiving concomitant fluphenazine decanoate. Am J Psychiatry 139: 104 - 106, 1982.PubMedGoogle Scholar
  68. 68.
    Becker RE: Implications of the efficacy of thiothixene and a chlorpromazine-imipramine combination for depression in schizophrenia. Am J Psychiatry 140: 208211, 1983.Google Scholar
  69. 69.
    Spitzer RL, Endicott J, Robins E: Research diagnostic criteria: Rationale and reliability. Arch Gen Psychiatry 35: 773 - 782, 1978.PubMedCrossRefGoogle Scholar
  70. 70.
    Lorr M, Klett CJ: Inpatient Multidimensional Psychiatric Scale. Palo Alto, Calif, Consulting Psychologists Press, 1966.Google Scholar
  71. 71.
    Prusoff BA, Williams DH, Weissman MM, et al: Treatment of secondary depression in schizophrenia. Arch Gen Psychiatry 36: 569 - 575, 1979.PubMedCrossRefGoogle Scholar
  72. 72.
    Astrachan BM, Harrow M, Adler D, et al: A checklist for the diagnosis of schizophrenia. Br J Psychiatry 121: 529 - 539, 1972.PubMedCrossRefGoogle Scholar
  73. 73.
    Raskin A, Schuterbrandt JG, Reading N, et al: Differential response to chlorpromazine, imipramine, and placebo. Arch Gen Psychiatry 23: 164 - 173, 1970.PubMedCrossRefGoogle Scholar
  74. 74.
    Derogatis LR, Lipman R, Covi L: SCL 90. An outpatient psychiatric scale. Preliminary report. Psychopharmacol Bull 9: 13 - 27, 1973.PubMedGoogle Scholar
  75. 75.
    Schooler N, Hogarty J, Weissman MM: in Resource Materials for Community Mental Health Program Evaluations, Edited by Hargreaves WA, Attkisson CC, Sorensen JE. Second edition, US Dept of Health, Education, and Welfare publication. ADM 77328, 1977.Google Scholar
  76. 76.
    Singh AN, Saxena B, Nelson HL: A controlled clinical study of trazodone in chronic schizophrenic patients with pronounced depressive symptomatology. Curr Ther Res 23: 485 - 501, 1978.Google Scholar
  77. 77.
    Feighner JP, Robins E, Guze SG, et al: Diagnostic criteria for use in psychiatric research. Arch Gen Psychiatry 26: 57 - 63, 1972.PubMedCrossRefGoogle Scholar
  78. 78.
    Siris SG, Morgan V, Fagerstrom R, et al: Adjunctive imipramine in the treatment of post-psychotic depression: A controlled trial. Arch Gen Psychiatry 44: 533 - 539, 1987.PubMedCrossRefGoogle Scholar
  79. 79.
    Endicott J, Spitzer RL: A diagnostic interview: The schedule for affective disorders and schizophrenia. Arch Gen Psychiatry 35: 837 - 844, 1978.PubMedCrossRefGoogle Scholar
  80. 80.
    Gram I, Reisby N, Ibsen I, et al: Plasma levels and antidepressant effect of imipramine. Clin Pharmacol Ther 19: 318 - 324, 1976.PubMedGoogle Scholar
  81. 81.
    Glassman AH, Perel JM, Shostak M, et al: Clinical implications of imipramine plasma levels for depressive illness. Arch Gen Psychiatry 34: 197 - 204, 1977.PubMedCrossRefGoogle Scholar
  82. 82.
    Siris SG, Adan F, Cohen M, et al: Targeted treatment of depression-like symptoms in schizophrenia. Psychopharmacol Bull 23: 85 - 89, 1987.PubMedGoogle Scholar
  83. 83.
    Siris SG, Strahan A: Continuation and maintenance treatment trials of adjunctive imipramine in post-psychotic depression. J Clin Psychiatry, in press.Google Scholar
  84. 84.
    Siris SG, Cutler J, Owen K, et al: Maintenance imipramine treatment following post-psychotic depression. Psychopharmacol Bull, in press.Google Scholar
  85. 85.
    Brenner R, Shopsin B: The use of monoamine oxidase inhibitors in schizophrenia. Biol Psychiatry 15: 633647, 1980.Google Scholar
  86. 86.
    Siris SG, Rifkin A: Drug treatment of depression in patients with schizophrenia, in Schizophrenia and Affective Disorders: Biology and Drug Treatment. Edited by Rifkin A. Boston, John Wright PSG, 1983.Google Scholar

Copyright information

© Springer Science+Business Media New York 1989

Authors and Affiliations

  • Samuel G. Siris
    • 1
  1. 1.Hillside HospitalGlen OaksUSA

Personalised recommendations