Abstract
The purpose of this review is to analyze approaches to the treatment of depressive and negative disorders in schizophrenia in terms of their level of efficacy and safety. Materials and Methods: A search was conducted for full-text articles published over the last 10 years in PubMed, Springer, Wiley Online Library, Taylor & Francis Online, APA PsycInfo, CORE, Science Direct, and eLIBRARY.RU databases. Several articles published previously to this period were also included into the review due to their high scientific value. Results: Our review suggests that antidepressants (ADs) are effective medications and they can be prescribed to correct depressive disorders and negative symptoms in patients with schizophrenia when used in combination with antipsychotics (АPs). However, when administering ADs and АPs combinations, it is important to consider the safety profile of these combinations as well as their tolerance. Negative symptoms of schizophrenia, including those induced by a number of АP, are less amenable to correction by АDs monotherapy, which requires a long period of АPs (on average - 8 weeks), which can be limited in the real life of the patient outside the hospital. Current approaches to the therapy of depressive disorders in patients suffering from schizophrenia vary from country to country. However, most of АDs used in clinical psychiatric practice are widely used in the comorbid state under consideration. Conclusion: The efficacy and safety of АDs of the different classes considered in this review depends on their mechanisms of action, duration of admission, type of АPs taken, and specific clinical situation (acute depressive disorder, major depressive episode, or chronic depressive episode). Most promising in clinical practice are serotonin–norepinephrine reuptake inhibitors (SNRIs) and dual ADs. The use of tricyclic antidepressants (TCAs) is limited due to a higher risk of adverse drug reactions (ADRs). The use of most selective serotonin reuptake inhibitors (SSRIs) is limited due to the risk of aggravation of hallucinations (this risk being higher for patients with visual hallucinations, and lower for those with auditory hallucinations) and\or iatrogenic psychosis. These ADRs may probably occur in patients suffering from schizophrenia due to their ideal "poor metabolizer" pharmacogenetic profile, since most of the drugs considered in this review have hepatic metabolism.
Highlights
Depressive disorders in patients with schizophrenia are the most common comorbid conditions, caused by the influence of external environmental [1], genetic [2], and epigenetic factors and their combinations
Modern approaches to the treatment of depressive disorders in patients suffering from schizophrenia vary in different countries, but most of the ADs used in clinical psychiatric practice are widely used to treat this comorbid condition
The efficacy and safety of АDs of the different classes considered in this review depends on their mechanisms of action, duration of admission, type of АPs taken, and specific clinical situation
Summary
Depressive disorders in patients with schizophrenia are the most common comorbid conditions, caused by the influence of external environmental [1], genetic [2], and epigenetic factors and their combinations. Depressive disorders worsen the course of schizophrenia, reduce the effectiveness of APs therapy, increase the risk of developing psychoses, suicidal attempts, and completed suicides [3]. Therapy of depressive disorders largely depends on methodological approaches to their diagnosis [4]. Approaches to the selection of ADs and their combination with the taken APs in patients with schizophrenia may be limited due to the peculiarities of the drug-drug interaction, as well as due to genetically determined changes in pharmacokinetics and pharmacodynamics. The medications are broken down very slowly in poor metabolizers. These patients may experience adverse drug reactions (ADRs) at standard doses [7, 8]. The use of ADs in these patients with schizophrenia can lead to an increase in the severity of positive symptoms, the development of acute psychoses as well as other serious ADRs [9]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
