[Antidepressant treatment of schizophrenic patients]

The frequency of depression is extremely high in schizophrenia, about 60%. Depression much suffering, as evidenced by out patient suicides. As early as 1920, Mayer Gross, and more recently Widroe, identified this kind of depression under the name of post-psychotic depression. This definition deserves to be interpreted in several ways: depression differentiated negative symptoms; only the mood disorder is then characteristic and the other symptoms are part of the deficiency syndrome, depression can be integrated to schizophrenia or on the contrary it can be considered as independent of it and interpreted as reactive, secondary--for example as a morning phase for delusions, the iatrogenic effect of neuroleptics and depressogenic self-medication should not be overlooked. The issue that must be raised before instituting therapy is whether the disinhibitory effect of antidepressants may lead to the resurgence of delusions. After reviewing the literature and in the light of a personal study, the authors answer in the negative. Based on a preliminary study in 10 patients with essentially paranoid schizophrenia, treated with fluoxetine 20 mg per day, the author observed an improvement in sadness, sleep, death wishes in 7 patients, without exacerbation of delusions. It is legitimate to ask, with Lindenmayer, which place depression could take as a "blind factor" alongside with negative and positive factors of schizophrenia.