Antidepressants and schizophrenia

Schizophrenia and depression commonly occur together, and antidepressants may be prescribed in combination with antipsychotics to treat both conditions. Antidepressant medicines affect brain chemicals (neurotransmitters) and can provide relief from symptoms of depression and anxiety. Combining antidepressants with antipsychotic medicines has been found to work well in treating the negative symptoms (such as lack of emotion or motivation) of schizophrenia.

Antidepressants that may be used to treat depression that occurs with schizophrenia include:

• Selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft) or citalopram (Celexa).
• Tricyclic antidepressants, such as nortriptyline hydrochloride (for example, Pamelor).

Antidepressants are usually started at low doses and gradually increased until symptoms get better. It may take several weeks for you to feel relief from symptoms of sadness or loss of interest in things that you once enjoyed.

Side effects of SSRIs can include:

• Nausea, loss of appetite, and diarrhea.
• Anxiety or drowsiness.
• Sleep problems.
• Loss of sexual desire or ability.
• Headaches.

Side effects of tricyclics include:

• Stomach upset and other problems, such as constipation.
• Dry mouth, blurred vision, and drowsiness.
• Lowered blood pressure.
• Weight gain.
• Tremors and sweating.
• Inability to urinate (urinary retention).
• Loss of sexual desire or ability.
• Confusion or delirium in older adults.

Not everyone experiences side effects from these medicines, and antidepressants can be very helpful in treating depression in someone with schizophrenia.

FDA Advisory. The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when the doses are changed.

For more information on antidepressants, see Drug Reference. (Drug Reference is not available in all systems.)