The Clinical Management of Depressive Symptoms in Greek Patients with Schizophrenia: Outcomes of the “elpis” Study

Abstract

Patients with schizophrenia often experience depressive symptoms, while the overlap between depressive and negative symptoms introduces inherent complexity in making accurate diagnosis and initiating appropriate treatment. Using antidepressant medication (SSRI/SNRIs, tricyclic antidepressants, MAOIs, NDRIs) to treat depressive symptoms associated with schizophrenia is a common therapeutic approach, but remains controversial. The primary objective of the 'ELPIS” study was to determine the prevalence and degree of depressive symptoms in clinically stable adult Greek outpatients with schizophrenia. Secondary endpoints included management patterns of stabilized outpatients with schizophrenia with depressive symptomatology and comparison between those with and without depressive symptoms. The target was to explore possible patterns in therapeutic approaches during the maintenance phase of schizophrenia in patients with and without depressive symptoms. 'ELPIS” is a multicentre, national, cross-sectional, observational study of stabilized outpatients with schizophrenia. 392 patients were recruited over a 5-month period (172 with depressive symptoms, 220 without). The study cohort included a single-patient visit within a normal clinical practice setting: all study-related information was collected retrospectively, through medical chart review and patient interview. Treatment with antidepressants was more common for patients with depressive symptoms (CDSS score>6) compared to patients without (70.1% vs 29.9%, p<0.001). Treatment with typical antipsychotic was less common for these patients (32.3% vs 67.7%, p=0.04). Differences in use of other medication classes, monotherapy/combination therapy, comorbidities and socio-demographic characteristics were not statistically significant. Treatment with antidepressants, while still controversial, is more common in patients with schizophrenia with depressive symptoms than in those without.