Depression in patients with schizophrenia - Prevalence, and diagnostic andtreatment considerations

Depression is a common comorbid syndrome in patients with schizophrenia. A review of the literature highlights the multitude of different expressions used to describe depression in this context. This fact exemplifies the diag nostic and therapeutic inconsistencies found in literature. Former generations of psychiatrists considered that antidepressants could p rovoke psychotic symptoms. Although the evidence is still tentative, it app ears to be current common practice for most psychiatrists, having ruled out confounding conditions such as extrapyramidal motor symptoms and negative symptoms, to prescribe antidepressant agents to patients who show depressiv e symptoms. There are controlled clinical trials that have demonstrated tha t tricyclic antidepressants are effective in the treatment of depression in patients with schizophrenia. In contrast, the newer antidepressants have y et to be tested in large scale controlled studies. Possible interactions be tween antipsychotics and antidepressants must be considered when these two classes of agent are prescribed. Monotherapy with novel antipsychotics may be a treatment option, as some su ch as zotepine, olanzapine and risperidone have shown advantages over tradi tional antipsychotics in reducing depressive symptoms in patients with schi zophrenia. Others have some pharmacological properties that resemble antide pressant drugs.