Prodromal Schizophrenia in Adolescents: Role for Antidepressants?

Early intervention in psychiatric disorders such as schizophrenia can have a wide range of effects on patient symptoms and outcome. A recent study published in the Journal of Clinical Psychiatry reported improvements with antidepressants and atypicals in adolescents in the "prodromal" stage of schizophrenia, although a psychotic disorder later developed in a quarter of the adolescents treated with atypicals.

Forty-eight adolescents (mean age, 15.8 years), who were participants in the initial phase of the Recognition and Prevention Program, were selected based on the criteria that they displayed attenuated positive symptoms, were treated pharmacologically for at least 8 weeks, and had been followed up for at least 6 months. Antidepressants (n = 20) or atypical antipsychotics (n = 28) were naturalistically prescribed, with polypharmacy common.

Psychotic disorders developed in 25% of adolescents. Atypicals had been prescribed for all of these patients, but 11 of 12 were nonadherent to their medication regimen. No psychotic disorders developed in the adolescents who were treated with antidepressants.

Adolescents were more likely to be nonadherent to atypicals (61%) than to antidepressants (20%). Significant improvement (P < .001) was noted in 3 of 5 positive symptoms over time-suspiciousness, unusual thoughts, and perceptual abnormalities-and was similar for the 2 medication groups. Two positive symptoms, grandiosity and conceptual disorganization, demonstrated no improvement. Disorganized thought did not improve regardless of treatment.

During a follow-up period of 6 months to 5 years, a number of adolescents were successfully treated using antidepressants. While acknowledging that conclusions were limited by some flaws in the study design, the authors said that the results suggest that beginning treatment with antidepressants and then progressing to antipsychotics might be preferable in some cases, given the poor adherence to the latter.