Postpsychotic depression

Abstract

Postpsychotic depression in schizophrenic patients affects roughly 60% of the patients. Against the background of the differences between ICD-10 and DSM-IV, and the clinical experience gained with the longterm course of chronic schizophrenia, however, the conceptualisation of postpsychotic depression as a depressive episode occurring solely immediately following a psychotic exacerbation in the remission phase, must be considered highly questionable. It is therefore proposed that, in addition to a purely postpsychotic depression in the sense of the word, a classification of depression in the interval should also be established, it being acknowledged, however, that in the latter, discrimination from the negative symptom syndrome of schizophrenia is particularly difficult. Apart from interesting new approaches in the area of cognitive behavioural therapy, pharmacotherapy employing antidepressants to treat postpsychotic depression has proved unhelpful. Instead, neuroleptic medication should be optimised by changing over to atypical neuroleptics which, on the basis of their other pharmacological mechanisms of action, also possess direct antidepressive properties. In the case of depression in an illness-free interval, the use of antidepressants can be more readily considered with either mirtazapine (e.g. Venlafaxine) or an SSRI being given preference, depending upon the severity of the persisting psychotic symptoms.