Most patients with schizophrenia take more than one type of psychiatric medication for their symptoms, but a new study published in the journal JAMA Psychiatry suggests that some combinations may be more effective than others.
Antipsychotic drugs are the first line of treatment for psychosis, but these drugs can fail to control schizophrenia symptoms on their own. Doctors often prescribe additional psychiatric medications, such as another antipsychotic, an antidepressant, a benzodiazepine, or a mood stabilizer.
“Antipsychotic medications are used to treat psychotic symptoms such as delusions and hallucinations but there is little guidance on what to do for other types of symptoms like depression, anxiety or excitement,” said lead author T. Scott Stroup, M.D., M.P.H., professor of psychiatry at Columbia University Vagelos College of Physicians and Surgeons in New York.
“Additional medications are often prescribed, but we know little about how different psychiatric drug combinations affect people with schizophrenia. Until now we have known virtually nothing about how these strategies compare to each other.”
For the study, the research team analyzed the Medicaid records of 81,921 adults with schizophrenia who had been taking only an antipsychotic drug for at least 3 months before starting either an antidepressant, benzodiazepine, mood stabilizer, or another antipsychotic drug.
The findings show that schizophrenia patients who added an antidepressant were less likely to end up in the emergency room or hospital for a mental health issue compared to patients who started another antipsychotic or a benzodiazepine.
In fact, antidepressants lowered the risk of hospitalization by 16 percent compared to antipsychotics and by 22 percent compared to benzodiazepines. For emergency room visits, antidepressants reduced the risk by 8 percent compared to antipsychotics and by 18 percent compared to benzodiazepines.
“Our study adds more evidence that benzodiazepine use should be limited and that combining antidepressants with antipsychotic drugs for individuals with schizophrenia may have benefits,” Stroup said. “We still need to know more about when to use antidepressants, which may be useful for conditions other than depression.”
Combining medications is often referred to as polypharmacy. “The results of our study should promote rational polypharmacy,” Stroup said. He believes that clinicians will find the results believable and hopes that they will lead to practice changes and improved patient outcomes.
Around 1 percent of the global population is diagnosed with schizophrenia, and approximately 1.2 percent of Americans (3.2 million) have the disorder.