Mood disorders in
schizophrenia are common and are associated with a poor outcome, an increased risk of relapse and a high rate of suicide. Consequently, treatment strategies need to take
mood disorders into account. In depressed and actively psychotic schizophrenic and schizoaffective patients, treatment with
neuroleptic plus
antidepressant may be less effective than
neuroleptic alone. However, patients with post-psychotic depression on maintenance
neuroleptics respond well to
tricyclic antidepressants.
Mood disorders can be caused by
neuroleptics and if so will often improve if the dose is reduced or if the
drug is changed.
Anticholinergics may also help. In
schizoaffective disorder,
lithium is usually beneficial, especially for patients with classical
affective disorder.
Carbamazepine may be more effective in patients with schizoaffective and
schizophreniform disorders. At doses comparable with those effective in
schizophrenia,
clozapine may be as good or better than conventional
neuroleptics in schizophrenic patients with
psychotic mood disorder or
schizoaffective disorder. In patients with high BPRS anxiety/depression scores,
risperidone (8 mg/day) was more effective than
haloperidol (10 mg/day).
Risperidone at a mean dose of 8.6 mg/day was also more effective than
haloperidol (mean dose 9.2 mg/day) or
levomepromazine (
methotrimeprazine -- mean dose 125 mg/day) on the Psychotic Anxiety Scale. Mood-related symptoms are therefore amenable to treatment.
Risperidone and
clozapine appear to be good candidates for the long-term treatment of
mood disorders in
schizophrenia, although long-term, double-blind, controlled studies are needed to confirm this.