Schizophrenia: adjunctive antidepressants may top antipsychotic switch

  • Stroup TS & al.
  • JAMA Psychiatry
  • 20 Feb 2019

  • curated by Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Patients taking antipsychotics for schizophrenia who need to change medication have a lower risk for psychiatric hospitalization and emergency department (ED) visits if they initiate adjunctive treatment with an antidepressant instead of alternative psychotropic medications.

Why this matters

  • The initiation of adjunctive benzodiazepines and mood stabilizers was associated with significantly higher rates of psychiatric hospitalization, ED visits, and mortality, suggesting clinicians should exercise caution in prescribing these medications adjunctively.

Study design

  • Study used data from US national Medicaid data from between January 2001 and December 2010 to evaluate 81,921 adult outpatients (age, 18-64 years) with schizophrenia who were stably treated with a single antipsychotic but required a change in pharmacotherapy.
  • Patients initiated use of a new antidepressant (n=31,117), benzodiazepine (n=11,941), or mood stabilizer (n=12,849) or a new alternative antipsychotic (n=26,014).
  • Funding: Patient-Centered Outcomes Research Institute.

Key results

  • Patients initiating treatment with antidepressants vs a new antipsychotic had lower risk for hospitalization (aHR, 0.84; 95% CI, 0.80-0.88) and ED visit (aHR, 0.92; 95% CI, 0.89-0.96).
  • Antidepressants vs a new antipsychotic use was associated with a lower risk for new-onset diabetes (aHR, 0.87; 95% CI, 0.79-0.96).

Limitations

  • Information regarding reason for change in medications not available.
  • No data for actual medication ingestion.

Coauthored with Antara Ghosh, PhD

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