Use of antidepressants and mood stabilizers in persons with first-episode schizophrenia

Abstract

Purpose Antipsychotics are first-line treatment of schizophrenia. They are often accompanied by adjunctive treatments, such as antidepressant (AD) or mood stabilizer (MS), although there is only limited information of their use in first-episode schizophrenia. This study aimed to investigate AD and MS initiation and factors associated with initiation in persons with first-episode schizophrenia. Methods Register-based data was utilized to identify persons who received inpatient care due to schizophrenia during 1996-2014 in Finland and who did not use AD or MS at the time of first inpatient care diagnosis of schizophrenia (N = 7667, mean age 40.2, SD 18.2). Drug purchase data (1995-2017) was obtained from the National Prescription register and modelled with PRE2DUP method. Initiations of AD and MS use were followed up 3 years from first schizophrenia diagnoses. Cox proportional hazard models were used to investigate factors associated with AD or MS initiation. Results Among persons with first-episode schizophrenia, 35.4% initiated AD and 14.1% initiated MS use within three years from diagnoses. Female gender, younger age, and benzodiazepine use were associated with higher risk of AD and MS initiation. The number of previous psychoses was associated with decreased risk of AD and increased risk of MS initiation. Conclusion Clinical guidelines rarely recommend the use of AD or MS as adjunctive treatment in persons with schizophrenia. However, this population is often treated with AD or MS. More studies are needed to evaluate benefits and risks of these medications as adjunctive treatment of schizophrenia.

Early intervention in psychosis: An analysis of the characteristics and service needs of patients over the age of 35

“…With 36% of ≤35s and 40% of >35s being on both. Although a high figure, this is in keeping with other published literature (Hanci et al, 2015; Puranen et al, 2020) Many patients with psychotic disorders have negative or depressive symptoms which can be managed in part with antidepressants. Therefore, these therapies are important part of treatment and help improve the patients' quality of life.…”

Real‐world effectiveness of mood stabilizer use in schizophrenia

“…The fact that the Finnish guideline mentions MS use as potentially beneficial may explain why MS use was relatively common in our cohort (28%), with almost one third of the patients using these medications at some point during their follow‐up. The prevalence of MS use in our study is in line with some previous studies where MS use prevalence varied from 27% to 29% 5,6 although both lower (14.1%) and higher (40.7%) prevalence figures have been reported previously 7,8 …”

Individual psychotherapy can reduce suicidal ideation in first episode psychosis: Further findings from the 2‐year follow‐up of the ‘Parma Early Psychosis’ programme

“…T A B L E 1 Clinical and sociodemographic characteristics of the FEP total sample (n = 232) Additionally, in the present research, antidepressant medication appears to crucially contribute in controlling suicidal thinking in people at the onset of psychosis, enhancing specialized psychosocial interventions (Puranen et al, 2020). However, clinical guidelines rarely recommend the use of antidepressant medication as adjunctive treatment in people with psychosis.…”