Depression and schizophrenia

Abstract

SummaryDepressive symptoms commonly occur in schizophrenia and have a significant impact on the distress and burden of the illness. Yet they are often overlooked, inadequately characterised by current classification systems and not consistently integrated into treatment. We discuss nosology, practical and clinical implications of symptom differentiation, and the role of causal and confounding factors, including iatrogenic, as targets for therapeutic intervention. The evidence base of psychosocial and psychotropic management is reviewed, with recommendations for the treatment of established syndromal depression in people with schizophrenia.

Associations between cognition and internalizing problems in young adults with early-onset schizophrenia: A 13-year follow-up study

“…Depression in schizophrenia has also been the focus of attention to a great extent, due to the important role it plays, particularly in the prodromal phase of the illness (Häfner, Löffler, Maurer, Hambrecht, & Heiden, 1999). But even so, depressive symptoms are sometimes overlooked in schizophrenia due to a focus on the treatment of psychotic symptoms (Castle & Bosanac, 2012), and in many cases symptoms of depression are confused with negative symptoms such as social withdrawal and apathy (Castle & Bosanac, 2012). Although depression has been the attention of much schizophrenia research, the relationship between depression and schizophrenia is still unclear (Heald, Morris, & Soni, 2008).…”

Treating depressive episodes or symptoms in patients with schizophrenia

“…Furthermore, feelings of hopelessness and guilt as well as suicidal thoughts are seen more frequently in the case of depressive symptomatology. 2,14 Because of these differences, it is recommended to use validated questionnaires to diagnose a depressive episode in patients with schizophrenia. For example, the Calgary Depression Rating Scale for Schizophrenia (CDSS) 15 is specifically designed to distinguish between depressive symptoms and other symptom domains (i.e., negative and or extrapyramidal side effects).…”

“…However, the number of studies investigating the effectiveness of antipsychotics for treating depressive episodes in schizophrenia specifically are limited, as shown in a Cochrane review by Furtado et al 33 Consider somatic causes and substance use disorder Based on the framework as designed by Castle and Bosnac. 14 The possible effects in this Cochrane review were expressed as "weighted mean differences" (WMDs), which calculate the difference between decreases of a score on a depression rating scale by different interventions, weighted by the pooled variance of these differences. From the few included studies in this review, one study compared sulpiride versus chlorpromazine with a double-blind design (in which it was unclear whether participants were randomly assigned to the treatment conditions).…”

“…However, some new studies that investigated the addition of antidepressants 10 to care as usual practice and the effectiveness of exercise 11 on depressive symptoms have not yet been included in recent guidelines and articles on this topic. [12][13][14] Therefore, the present review aims to give an overview of treatment possibilities for depressive episodes and symptoms in schizophrenia. Based on the current evidence, we will provide a stepwise approach that can be applied when treating a patient with schizophrenia and depressive episodes or symptoms.…”

Schizophrenia and depression

“…Most studies of psychological treatments for depression in schizophrenia have examined depression as a secondary or tertiary outcome measure and have generally not used well validated measures of mood, thereby limiting the evidence base 12 . The Schizophrenia Patient Outcomes Research Team guidelines 13 did not conclude effectiveness for any specific type of psychotherapy approach for depression in people with schizophrenia.…”