SAN ANTONIO – Longer follow-up supports earlier findings that subsyndromal symptoms of depression and suicidal ideation in middle-aged and older adults with schizophrenia or schizoaffective disorder might respond to treatment with a selective serotonin reuptake inhibitor, reported investigators at the annual meeting of the American Association for Geriatric Psychiatry.
In 24-week follow-up of a previously reported 12-week study, patients aged 40 years and older with schizophrenia or schizoaffective disorder whose regular antipsychotic therapy was augmented with the SSRI citalopram (Celexa) maintained a significant decrease in suicidal ideation scale scores, compared with similar patients on an antipsychotic and placebo, reported Dr. Ipsit V. Vahia from the Stein Institute for Research on Aging and Department of Psychiatry at the University of California, San Diego.
Patients with schizophrenia are 8-20 times more likely than is the general public to attempt suicide, and more than half of all people with schizophrenia have either suicidal ideation or attempt suicide. Suicide accounts from 5-13% of all deaths among people with schizophrenia, and is the leading cause of premature death in this population Dr. Vahia said.
Initial results of the trial were published last year (J. Clin. Psychiatry 2010;71:915-22). After 12 weeks of therapy with either citalopram at a flexible dose of 10-60 mg daily or placebo plus the patients’ standard antipsychotic agent, citalopram was associated with lower Beck Hopelessness Scale (BHS) scores (P less than .05), and lower likelihood of having suicidal ideation on both the InterSePT Scale for Suicidal Thinking (ISTT; P less than .005) and Hamilton Depression Rating Scale item 3 (P less than .05).
Citalopram was not associated with emergent (that is, treatment-related) suicidal ideation in 114 of the 198 participants with no suicidal ideation at baseline. Among 55 patients with suicidal thoughts or actions at baseline, 28.6% of those on the antidepressant still had such ideation at the study endpoint, compared with 66.7% of those on placebo (P less than .05). The effect of the drug on reduction in suicidal ideation was significantly greater among depression responders than non-responders (P less than .05).
Looking at secondary outcomes on the Positive and Negative Syndrome Scale, the investigators found that the antidepressant was significantly better at reducing negative symptoms of schizophrenia than placebo (P = .049). No significant effect of the drug was found on the other scale items of positive symptoms, depression, cognition, or excitement, however.
Dr. Vahia noted that 64% of patients in the placebo group and 65% in the citalopram group have completed 24 weeks of follow-up after the study taper. There were no changes in depression scores from scores from weeks 12 to 24, and the improvements seen with the citalopram group were maintained, he said.
The findings suggest that subsyndromal depression in older adults with schizophrenia is responsive to treatment with SSRIs, as demonstrated by reductions in depressive symptoms, suicidal ideation, and negative symptoms of schizophrenia, Dr. Vahia concluded.
The study was supported by grants from the National Institute of Mental Health and Department of Veterans Affairs. Medications were supplied by Forest Pharmaceuticals. Dr. Vahia had no conflict of interest disclosures.
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