Depressions in schizophrenia: some observations on prevalence, etiology, and treatment

The results suggest that not only is depression a common symptom or syndrome in all stages of schizophrenia, but it is common even in the absence of treatment. However, there are a number of reasons for thinking that a proportion of patients on drugs may well suffer from drug related depressions, possibly 7.5-12.5 per cent. A difference in the effect upon mood, in the acute schizophrenic state, between flupenthixol and fluphenazine, has already been suggested (Johnson & Malik (1975)). Current research (Johnson (1976, 1979)) suggests that regular neuroleptic maintenance therapy is necessary for many years, certainly for more than four years following the most recent relapse. It is therefore of particular importance to concern ourselves with all potential side-effects such as extrapyramidal symptoms, weight gain (Johnson & Breen (1979)) an tardive dyskinesia (Gibson (1978)), and to keep the patients on personalised dose regimes which can frequently be reduced with time, particularly over the first two years of treatment (Johnson (1975, 1977)). WE must equally be on our guard against unnecessary polypharmacy which ultimately increases the risks for an already greatly disadvantaged patient.