Treatment with antidepressants kept adolescent patients in the prepsychotic phase of schizophrenia from progressing to full psychosis or bipolar disorder more effectively than did treatment with antipsychotics, said Barbara A. Cornblatt, Ph.D., of Albert Einstein College of Medicine, New York, and her colleagues.
Because data from previous studies suggest that mental deterioration in schizophrenia patients might begin before the first psychotic episode, treating patients before they progress to full-blown psychosis might slow progression of illness and preserve psychosocial skills, the researchers said.
To assess the effectiveness of antidepressants on preventing progression to psychosis in adolescents, Dr. Cornblatt and her associates prescribed either antidepressants or second-generation antipsychotics to 48 adolescents who met criteria for prepsychotic schizophrenia (J. Clin. Psychiatry 2007;68:546–57). Dr. Cornblatt is a consultant for Eli Lilly & Co., and she has received financial support from Janssen L.P.
The antidepressant group included 20 patients who had never been treated with antipsychotics but had received antidepressants and other medications.
The second-generation antipsychotic group included 28 patients who had previously received antipsychotics alone or in combination with other medications.
The patients were assessed every 6 months during a follow-up period that lasted from 6 months to 5 years, and the symptoms were compared over time using the Scale of Prodromal Symptoms.
Overall, 12 of the 28 patients in the antipsychotic group but none of the patients in the antidepressant group converted to psychosis during the course of the study.
Of the 12 patients who converted, 7 progressed to syndromal schizophrenia, 4 progressed from an earlier prodromal phase to stronger schizophrenia symptoms, and 1 patient developed bipolar disorder with psychotic features.
The use of antipsychotics to treat prepsychotic adolescents is on the rise despite a lack of data, and more research is needed before such treatment becomes a standard practice, the researchers said. Their results suggest that medications other than antipsychotics might be beneficial for early intervention in patients at risk for developing full-blown schizophrenia.