Certain combinations of psychiatric medication may be more effective than others in treating patients with schizophrenia, a new study suggests. Combining medications is often referred to as polypharmacy.

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. Until now we have known virtually nothing about how these strategies compare to each other,"

said lead author T. Scott Stroup, MD, MPH, professor of psychiatry at Columbia University Vagelos College of Physicians and Surgeons.

Adjunctive Antidepressants

The researchers carried out 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.

They 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. We still need to know more about when to use antidepressants, which may be useful for conditions other than depression,"

said Stroup.

Stroup TS, Gerhard T, Crystal S, et al. Comparative Effectiveness of Adjunctive Psychotropic Medications in Patients With Schizophrenia JAMA Psychiatry. Published online February 20, 2019. doi:10.1001/jamapsychiatry.2018.4489

Image: Jon Olav Eikenes

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