Summary: A new study reveals some drug combinations may be more beneficial for those with schizophrenia. Researchers found people with schizophrenia who took antidepressants, in combination with other medications, were less likely to be hospitalized for mental health issues than those who started another antipsychotic.
Source: Columbia University.
Patients with schizophrenia are often treated with more than one type of psychiatric medication, but a new study suggests that some combinations may be more effective than others.
The findings were published in JAMA Psychiatry.
Antipsychotic drugs are usually the first line of treatment for individuals with schizophrenia. But because these drugs often fail to control symptoms adequately 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. Additional medications are often prescribed, but we know little about how different psychiatric drug combinations affect people with schizophrenia,” says T. Scott Stroup, MD, MPH, professor of psychiatry at Columbia University Vagelos College of Physicians and Surgeons and lead author of the paper. “Until now we have known virtually nothing about how these strategies compare to each other.”
To find out, the researchers conducted a comparative effectiveness study using 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 researchers found that individuals with schizophrenia who added an antidepressant were less likely to land in the emergency room or hospital for a mental health issue than those who started another antipsychotic or a benzodiazepine. Antidepressants reduced the risk of hospitalization by 16% compared to antipsychotics and by 22% compared to benzodiazepines. For emergency room visits, antidepressants reduced the risk by 8% compared to antipsychotics and by 18% 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,” says Stroup. “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,” added Stroup. He thinks that clinicians will find the results believable and hopes that they will lead to practice changes and improved patient outcomes.
The other authors of this paper are Tobias Gerhard, PhD (Rutgers University), Stephen Crystal, PhD (Rutgers University), Cecilia Huang, PhD (Rutgers University), Zhiqiang Tan, PhD (Rutgers University), Melanie M. Wall, PhD (Columbia University Irving Medical Center), Chacku Mathai, AAS (Mental Health Association of Rochester), and Mark Olfson, MD, MPH (Columbia University Irving Medical Center)
Funding: The study was supported by a Patient-Centered Outcomes Research Institute award (CER-1310-06750).
Dr. Stroup was an investigator in a clinical trial sponsored by Auspex Pharmaceuticals and participated in a CME presentation supported by an independent educational grant from Intra-Cellular Therapies, Inc. Dr. Gerhard reports receipt of an honorarium or consultation on a research study from Eli Lilly and Company, receipt of a research grant from Bristol-Myers Squibb, receipt of an honorarium from and participation in an external safety review committee for Merck & Co., and receipt of an honorarium from and service as an expert witness for Pfizer. Dr. Olfson reports serving on an advisory board for Lundbeck.
The authors report no additional financial or other conflicts of interest.
Source: Eian Kantor – Columbia University
Publisher: Organized by NeuroscienceNews.com.
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Original Research: Abstract for “Comparative Effectiveness of Adjunctive Psychotropic Medications in Patients With Schizophrenia” by T. Scott Stroup, MD, MPH; Tobias Gerhard, PhD; Stephen Crystal, PhD; Cecilia Huang, PhD; Zhiqiang Tan, PhD; Melanie M. Wall, PhD; Chacku Mathai, AAS; and Mark Olfson, MD, MPH in JAMA Psychiatry. Published February 20 2019.
Comparative Effectiveness of Adjunctive Psychotropic Medications in Patients With Schizophrenia
People with schizophrenia are commonly treated with psychotropic medications in addition to antipsychotics, but there is little evidence about the comparative effectiveness of these adjunctive treatment strategies.
To study the comparative real-world effectiveness of adjunctive psychotropic treatments for patients with schizophrenia.
Design, Setting, and Participants
This comparative effectiveness study used US national Medicaid data from January 1, 2001, to December 31, 2010, to examine the outcomes of initiating treatment with an antidepressant, a benzodiazepine, a mood stabilizer, or another antipsychotic among adult outpatients (aged 18-64 years) diagnosed with schizophrenia who were stably treated with a single antipsychotic. Data analysis was performed from January 1, 2017, to June 30, 2018. Multinomial logistic regression models were used to estimate propensity scores to balance covariates across the 4 medication groups. Weighted Cox proportional hazards regression models were used to compare treatment outcomes during 365 days on an intention-to-treat basis.
Main Outcomes and Measures
Risk of hospitalization for a mental disorder (primary), emergency department (ED) visits for a mental disorder, and all-cause mortality.
The study cohort included 81 921 adult outpatients diagnosed with schizophrenia (mean [SD] age, 40.7 [12.4] years; 37 515 women [45.8%]) who were stably treated with a single antipsychotic and then initiated use of an antidepressant (n = 31 117), a benzodiazepine (n = 11 941), a mood stabilizer (n = 12 849), or another antipsychotic (n = 26 014) (reference treatment). Compared with initiating use of another antipsychotic, initiating use of an antidepressant was associated with a lower risk (hazard ratio [HR], 0.84; 95% CI, 0.80-0.88) of psychiatric hospitalization, whereas initiating use of a benzodiazepine was associated with a higher risk (HR, 1.08; 95% CI, 1.02-1.15); the risk associated with initiating use of a mood stabilizer (HR, 0.98; 95% CI, 0.94-1.03) was not significantly different from initiating use of another antipsychotic. A similar pattern of associations was observed in psychiatric ED visits for initiating use of an antidepressant (HR, 0.92; 95% CI, 0.88-0.96), a benzodiazepine (HR, 1.12; 95% CI, 1.07-1.19), and a mood stabilizer (HR, 0.99; 95% CI, 0.94-1.04). Initiating use of a mood stabilizer was associated with an increased risk of mortality (HR, 1.31; 95% CI, 1.04-1.66).
Conclusions and Relevance
In the treatment of schizophrenia, initiating adjunctive treatment with an antidepressant was associated with reduced risk of psychiatric hospitalization and ED visits compared with initiating use of alternative psychotropic medications. Associations of benzodiazepines and mood stabilizers with poorer outcomes warrant clinical caution and further investigation.