For Patients with Schizophrenia, Some Drug Combinations May Be More Effective than Others

New York, NY (February 20, 2019)—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 study is titled, “Comparative Effectiveness of Adjunctive Psychotropic Medications in Patients with Schizophrenia.”

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)

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.

###

Columbia University Department of Psychiatry

Columbia Psychiatry is among the top ranked psychiatry departments in the nation and has contributed greatly to the understanding and treatment of brain disorders. Co-located at the New York State Psychiatric Institute on the NewYork-Presbyterian Hospital/Columbia University Irving Medical Center campus in Washington Heights, the department enjoys a rich and productive collaborative relationship with physicians in various disciplines at the Columbia University Vagelos College of Physicians and Surgeons. Columbia Psychiatry is home to distinguished clinicians and researchers noted for their clinical and research advances in the diagnosis and treatment of depression, suicide, schizophrenia, bipolar and anxiety disorders, eating disorders, substance use disorders, and childhood psychiatric disorders.

Columbia University Irving Medical Center provides international leadership in basic, preclinical, and clinical research; medical and health sciences education; and patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the Vagelos College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University Irving Medical Center is home to the largest medical research enterprise in New York City and State and one of the largest faculty medical practices in the Northeast. For more information, visit cumc.columbia.edu or columbiadoctors.org.