Adjunctive imipramine for a broader group of post-psychotic depressions in schizophrenia

• Published in: Schizophrenia research 2000-09, Vol.44 (3), p.187-192
• Main Authors: Siris, Samuel, Pollack, Simcha, Bermanzohn, Paul, Stronger, Roslyn
• Format: Article
• Language: English
• Subjects: Adjunctive medication strategy; Adult; Antidepressant medication; Antidepressive Agents, Tricyclic - therapeutic use; Antipsychotic Agents - therapeutic use; Benztropine - therapeutic use; Biological and medical sciences; Depressive Disorder, Major - diagnosis; Depressive Disorder, Major - drug therapy; Depressive Disorder, Major - etiology; Double-Blind Method; Drug Therapy, Combination; Female; Fluphenazine - therapeutic use; Humans; Imipramine - administration & dosage; Imipramine - therapeutic use; Male; Medical sciences; Muscarinic Antagonists - therapeutic use; Neuroleptic medication; Neuropharmacology; Pharmacology. Drug treatments; Post-psychotic depression; Psychiatric Status Rating Scales; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopharmacology; Psychotic Disorders - psychology; Schizophrenia; Schizophrenia - complications; Schizophrenic Psychology; Severity of Illness Index; Time Factors
• ISSN: 0920-9964; 1573-2509
• DOI: 10.1016/S0920-9964(99)00197-8

As an expansion of work examining the usefulness of adjunctive imipramine added to fluphenazine decanoate and benztropine in the treatment of post-psychotic depression, a previously successful and informative protocol was extended to a larger and more heterogeneous cohort of clinic and day-treatment patients. Although the benefit of the adjunctive antidepressant strategy was still observable in the total sample, as calculated by the prospectively intended data analysis, the findings were weaker than those obtained for the initial cohort. Owing to the possibility that differences between the later and earlier cohorts might account for the muted nature of the benefit, a post-hoc analysis was undertaken. This revealed that the later cohort was sicker in general and more psychotic in particular. The later cohort was also treated with lower doses of neuroleptic medication while remaining out of hospital longer, consistent with more recent treatment trends. It was also possible that the later cohort was subtly selected for more refractoriness of depression, since treatment of post-psychotic depression with adjunctive antidepressants had become more commonplace, and patients responding to this in general practice would not have gone on to be referred to the study. Thus a benefit from adjunctive antidepressant medication persists, but more remains to be learned about its character and likelihood in specific situations.