Dr. Holroyd and Dr. Cohen Reply

Abstract

Am J Psychiatry 148:4, April 1991 547 Carpenter argue that schizophrenic patients may be more depressed than normal control subjects in every time period. If so, how would this finding be interpreted? Would it be helpful to postulate a different etiology and nosology for depression in each time period, or would it be more parsimonious to conclude that schizophrenic patients have more depression in general than do normal control subjects (because of factors such as stressful life events, reduced processing capacity, or abnormal neurotransmitter systems)? Finally, the finding by Mandet et at. that Ms. Summerfelt and Dr. Carpenter cite is potentially problematic. If patients can suffer “postpsychotic” depression any time up to 45 weeks after a psychotic episode, the question becomes, What does not constitute postpsychotic depression? To be sure, some depressive episodes occurred in each of the time penods in our study. We think that the term “postpsychotic depression” implies a clinical (if not a causal) connection between psychotic and depressive episodes, and we specifically evaluated whether this connection takes the form of an increased frequency of onsets of depression following onsets of psychotic symptoms. Our breakdown of the various time periods was admittedly arbitrary, but we failed to find any deviation from random occurrence of onset of depression except for the concurrent period.