Psychological Medicine

Review Article

Antidepressants for the treatment of depression in people with schizophrenia: a systematic review

C. WHITEHEAD a1, S. MOSS a1, A. CARDNO a1 and G. LEWIS a1c1
a1 Bro Taf Health Authority and University of Wales College of Medicine, Cardiff; and Department of Psychiatry, University of Bristol

Article author query
whitehead c   [PubMed][Google Scholar] 
moss s   [PubMed][Google Scholar] 
cardno a   [PubMed][Google Scholar] 
lewis g   [PubMed][Google Scholar] 


Background. Depression is common in people with schizophrenia and is associated with substantial morbidity and an increased risk of suicide. Our aim was to review systematically all the randomized controlled trials that have investigated the clinical effectiveness of antidepressant medication in the treatment of depression in people who also suffer with schizophrenia.

Method. Electronic searches of ClinPsych, the Cochrane Library, the Cochrane Schizophrenia Group's Register of Trials, EMBASE and Medline were completed. Reference lists from identified articles were hand searched.

Results. Eleven small studies were identified and all randomized fewer than 30 subjects to each group. We could only perform analyses on a subset of the trials. For five trials (aggregate N=209) the proportion improved in the antidepressant group was 26% (95% CI 10% to 42%) higher than in the placebo group. In six studies (aggregate N=267) the standardized mean difference on the Hamilton Rating Scale for Depression at the end of the trial was −0·27 (95% CI −0·7 to 0·2). There was no evidence that antidepressant treatment given during the stable phase of illness led to a deterioration of psychotic symptoms in the included trials.

Conclusions. The literature reviewed was, overall, of poor quality and only a small number of trials could contribute towards the meta-analysis. The results provide weak evidence for the effectiveness of antidepressants in those with schizophrenia and depression and could be explained by publication bias. We need further research to determine the best approach towards treating depression in people with schizophrenia.

c1 Professor Glyn Lewis, University of Bristol, Cotham House, Cotham Hill, Bristol BS6 6JL.