AUGMENTATION WITH FLUVOXAMINE BUT NOT MAPROTILINE IMPROVES NEGATIVE SYMPTOMS IN TREATED SCHIZOPHRENIA - EVIDENCE FOR A SPECIFIC SEROTONERGIC EFFECT FROM A DOUBLE-BLIND-STUDY

There is considerable evidence that adding selective serotonin reuptak e inhibitor (SSRI) antidepressants to antipsychotic treatment improves negative symptoms of schizophrenia. This augmentation effect may be d ue to ''nonspecific'' antidepressant action or be specifically related to action on the serotonergic system. This study examined the seroton ergic specificity of SSRI augmentation by comparing an SSRI antidepres sant with a comparably effective antidepressant acting via the noradre nergic system. Consenting patients having chronic schizophrenia with p rominent negative symptoms were studied. Either fluvoxamine or maproti line was added to their regular antipsychotic treatment in a double-bl ind manner for 6 weeks. Patients were assessed using the Brief Psychia tric Rating Scale, the Scale for the Assessment of Negative Symptoms, the Scale for the Assessment of Positive Symptoms, the Montgomery-Asbe rg Depression Rating Scale (MADRS), and the Neurological Rating Scale for Extrapyramidal Side Effects. Twenty-five patients completed the st udy. Negative symptoms improved significantly in the fluvoxamine group , but not in the maprotiline group. MADRS scores, which were low, did not change significantly in either group. Positive symptoms were not a ffected by either treatment. It is concluded that the mechanism by whi ch fluvoxamine augmentation improves negative symptoms involves the se rotonergic system and is distinct from its antidepressant action.