Treatment of depression in schizophrenia: Systematic review and meta-analysis
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Background: Depression in schizophrenia predicts poor outcomes, including suicide, yet the effectiveness of antidepressants for its treatment remains uncertain. Aims: To synthesise the evidence of the effectiveness of antidepressants for the treatment of depression in schizophrenia. Method: Multiple databases Were searched and inclusion Criteria included participants aged over 18 years with schizophrenia or related psychosis with a depressive episode. Papers were quality assessed used the Cochrane risk bias tool. Meta-analyses were performed for risk difference and standardised mean difference of all antidepressants, antidepressant class and individual antidepressant where sufficient studies allowed. Results: A total of 26 moderate- to low-quality trials met inclusion criteria. In meta-analysis a significant risk difference was found in favour of antidepressant treatment, with a number needed to treat of 5 (95% CI 4–9). Studies using tools specifically designed to assess depression in schizophrenia showed a larger effect size. However, after sensitivity analysis standardised mean difference of all antidepressants did not show a statistically significant improvement in depression score at end-point, neither did any individual antidepressant class. Conclusions: Antidepressants may be effective for the treatment of depression in schizophrenia, however, the evidence is mixed and conclusions must be qualified by the small number of low- or moderate-quality studies. Further sufficiently powered, high-quality studies are needed.
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Depression is highly comorbid in schizophrenia and treatment options are limited.
“Depression is highly comorbid in schizophrenia and treatment options are limited [112]; thus, future well-powered RCTs are required that specifically include people with schizophrenia and depression to elucidate if exercise can improve depressive symptoms.”
From Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes (2020) · cites this paper as [112]
There is encouraging evidence for resistance training in people with elevated mental health symptoms.
“There is encouraging evidence for resistance training in people with elevated mental health symptoms [108-114], but this requires further testing in those with mental disorders.”
From Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes (2020) · cites this paper as [112]
The Discussion and Clinical recommendations address antidepressants for depression in schizophrenia, not resistance training. Searches for resistance training, strength training, exercise, and elevated mental health symptoms found no passage assessing the claim. (LLM, conf=0.78)
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References 50 · Cited by 109
Research works printed but not linked: 1
- [23]23. Singh AN, Saxena B, Nelson HL. A controlled clinical study of trazodone in chronic schizophrenic patients with pronounced depressive symptomatology. Curr Ther Res 1978; 23: 485-501.
- Authors
- Gregory, A., Mallikarjun, P., & Upthegrove, R.
- Affiliations
- University of Birmingham (GB)
- Corresponding author
- Upthegrove, Rachel
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2017-10
- Volume
- 211
- Issue
- 4
- Pages
- 198-204
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2752175942
- Cited by
- 109
- References
- 50
- Citations by year
- 2026: 11 · 2025: 10 · 2024: 16 · 2023: 11 · 2022: 10 · 2021: 14 · 2020: 13 · 2019: 12 · 2018: 11 · 2017: 1
- FWCI
- 1.54
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- depression in schizophrenia, antidepressants, treatment effectiveness, depressive episodes, psychosis, number needed to treat, suicide risk
- MeSH terms
- Antidepressive Agents, Depression, Humans, Schizophrenia
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