Clinical significance, evaluation, and management of secondary depression in schizophrenia

Treatment of the chronic schizophrenic patient is often complicated by depressive symptoms that can be difficult to detect. Because of the association between depressive symptoms and poor outcome features, the presence of these symptoms has substantial treatment implications. Treatment issues for depressive schizophrenic patients include selecting appropriate drug therapy, overcoming high rates of noncompliance, dealing with self-doubt and social withdrawal, and protecting patients from recurrent depressive symptomatology, suicide, or psychotic relapse. Controlled studies suggest that neuroleptic therapy is the drug treatment of choice; addition of an antidepressant does not appear to enhance therapeutic efficacy and may be associated with increased adverse effects. Successful treatment also requires the use of assertive case management, community support, family support, and careful patient education.