Schizophrenia Daily News Blog

Early Treatment with Antidepressants May Prevent Schizophrenia

New, but very preliminary, research suggests that we may be able to treat early schizophrenia symptoms (and prevent the development of full-blown schizophrenia) with antidepressant medications. This is exciting news - but of course its too early to tell how valid this study is until additional studies are done to validate the findings. More on this story in a moment - but first a bit of a background information:

Schizophrenia typically begins during late teens and early 20s for males (slightly later in females)and is characterized by dramatic misperceptions of reality. Often, there is an early "prodromal" period in which suggestive signs of the illness are seen but the actual disorder has not yet appeared.

During the past decade researchers have tried to stop the development of schizophrenia with medication during this early phase. In these studies (which we've reported on in the past - here and here ) In these past studies research groups identified patients with early schizophrenia (prodromal) symptoms, then treated some of them early on with second-generation ("atypical") antipsychotic drugs. These studies showed that the early treated patients had a much lower rate of development of schizophrenia than patients not treated with the antipsychotic medication.

The problem with the studies is that some of the patients with the early schizophrenia symptoms did not go on to develop full-blown schizophrenia, with or without treatment. And a number of the people treated developed the common significant side effects from the drugs, which includes significant weight gain and an increased risk of diabetes or other problems with sugar metabolism.

These issues resulted in an ethical challenge: is it appropriate to expose patients who seem at high risk to develop schizophrenia to a potentially risky treatment if some portion of these patients might not need it and might suffer side effects? Given this problem most researchers stopped advocating antipsychotic treatment for patients with early schizophrenia symptoms and instead tried to establish which early schizophrenia symptoms are most likely to accurately predict the eventual development of full-blown schizophrenia.

New research out of Australia suggests that we may be able to treat early schizophrenia symptoms and thereby prevent the development of full-blown schizophrenia with antidepressant medications that are free of the side effects that are commonly associated with antipsychotic medications.

The new research was recently reported by Barbara Cornblatt of the Albert Einstein School of Medicine. Dr. Cornblatt's team studied a group of 48 teens who had early schizophrenia (prodromal) symptoms.

The teens were treated by a psychiatrist who was not directly involved in the research and who had independently decided to give them either antidepressants or one of the newer "atypical" antipsychotic drugs.

Because the prescribing psychiatrists were free to choose the type of medication they thought would work best, we can compare results only by class of drug, not by individual medication. Nine different antidepressants — mostly SSRIs — were used for patients in the antidepressant group and four different second-generation antipsychotics were used for people in the second group.

In this study, in which all 48 teens where showing early symptoms of schizophrenia - not one of the 20 patients treated with the antidepressant went on to develop a psychotic illness (i.e. schizophrenia or any related psychosis such as bipolar disorder), whereas 12 of the 28 patients treated with the antipsychotic (or 43 percent) developed schizophrenia despite the treatment (and 57% did not develop schizophrenia with the antipsychotic medication treatment).

Researchers emphasize caution in the interpretation of this finding because this could simply be a case where the patients already verging on schizophrenia were showing slightly more prominent signs of the symptoms and were more likely to be started on an antipsychotic medication. However, if this finding holds up in future studies in which patients are randomly assigned to treatment groups, it would be tremendously exciting. Perhaps, for the first time, we could have a safe and effective method to prevent the development of schizophrenia.

Interestingly - research has shown that cognitive behavioral therapy (CBT) for depression influences brain chemicals in the same way that antidepressant medications do - and moreover, research out of Germany and other research centers suggests that CBT may also be effective in prevention of schizophrenia. Importantly - cognitive behavioral therapy for depression is already available on the internet for free - and for pay - at the following web sites.

Moodgym (free)
Ultrasis - for Pay - Depression, Anxiety

We'd like to see some studies that incorporate both CBT (live and internet-based) and antidepressant medications as possible prevention strategies in schizophrenia.

Source: Slate

Source Research Study: Can antidepressants be used to treat the schizophrenia prodrome? Results of a prospective, naturalistic treatment study of adolescents.