Venlafaxine for the treatment of depressive episode during the course of schizophrenia

The emergence of depression in the course of schizophrenia is common and arouses much interest and therapeutic concern. It has been associated with a less favorable prognosis and increased incidence of suicide. However, relatively few treatment studies have been performed in this area. The use of a combination of antidepressants and antipsychotic agents is controversial. We report an open-label study carried out to evaluate the efficacy of the addition of venlafaxine in schizophrenia patients treated with antipsychotics and diagnosed with concurrent depressive episode (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria). Patients (N = 19) who did not show spontaneous improvement after 4 weeks were assigned to a 6-week trial with add-on venlafaxine. Patients were evaluated at a 1-week interval with the Hamilton Depressive Rating Scale, the Positive and Negative Syndrome Scale, and the Clinical Global Impression Scale. All 19 patients had completed the 6-week trial. Fourteen patients (74%) showed significant improvement measured with Hamilton Depressive Rating Scale and Clinical Global Impression Scale. The mean venlafaxine dose was 146 mg/d (range: 75 to 225 mg/d). In most patients, there was a parallel decrease in psychotic symptoms. We conclude that venlafaxine may have a role in the treatment of depression in patients with schizophrenia without causing exacerbation of psychosis.