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Patients with Early Onset Psychosis May Respond to Depression Treatment

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Patients with early-onset psychosis may benefit from treatment for depression, including taking antidepressants alongside other medications, according to a new study at the University of Birmingham’s Institute for Mental Health in the U.K.

Depression is often identified alongside psychotic disorders such as schizophrenia in the early stages of the disorder but is not currently routinely treated. In fact, depression may be an intrinsic part of early phase psychotic disorders that should be treated together with other more prominent symptoms to improve patient outcomes, say the researchers.

“Our results suggest that depression is absolutely inherent in early phases of schizophrenia and so may one of the most important factors that we can target with treatments,” said study leader Professor Rachel Upthegrove from the University of Birmingham’s Institute for Mental Health.

“We know that depression in patients with schizophrenia frequently leads to poorer outcomes, and so understanding how treatment such as antidepressants might be used to improve these outcomes could be a big step forward.”

The findings are published in the journal Schizophrenia Bulletin.

For the study, the research team investigated the links between depression and psychosis, and particularly whether there were similarities in brain structure that could help future diagnostic pathways at an early stage.

Data was gathered from 1,700 patients as part of the PRONIA study, a large scale European study which uses machine learning to find ways to predict how people with recent-onset psychosis might recover.

The researchers looked at demographic and clinical data along with detailed symptom measures and neuroimaging information from a structural MRI scan from patients with recent-onset psychosis as well as recent-onset depression.

They analyzed the data using machine learning software to try to determine whether it is possible to identify a subgroup of patients with distinct symptoms of both depression and psychosis.

They found little difference in either the patients’ depressive symptoms or in the structural brain changes in patients with depression, with and without psychosis. This shows that there is no subgroup of patients with both depression and psychosis, but rather that depression may be an intrinsic part of a majority of patients’ psychosis.

The team argues their findings show that treatments focused on depression may well be an effective additional first-line treatment for psychosis, to be given alongside regular interventions.

“Machine learning is a tool that has the potential to help solve the diagnostic and treatment conundrums that the complexity of mental health disorders present, and analyses using multimodal data are needed to advance the field,” said Paris Lalousis, a Priestly Ph.D. Fellow at the University of Birmingham and the University of Melbourne.

“Our results show that using a principled approach and both psychopathological and biological factors can shed light on the experiences of patients with depression in early psychosis.”

The researchers have already begun a clinical trial to test the approach in patients. The ADEPP trial will test people in the first stages of psychosis who take antidepressants alongside antipsychotic drugs. The trial will assess over a six month period whether the antidepressants have an effect on the patients’ ability to recover from their psychosis.

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Schedule10 Jun 2023