Antidepressant prescribing patterns among VA patients with schizophrenia

Background: Recent reviews have questioned the efficacy of adjuvant use of antidepressants for the treatment of depression or the treatment of primary negative symptoms among individuals with schizophrenia. Methods: Using administrative data from the VA's mid-Atlantic region this cross-sectional retrospective study provides estimates of receipt of prevalent and incident antidepressant medications in fiscal year 2007 (FY07) among 2412 veterans receiving treatment for schizophrenia. Multivariable logistic regression analyses were used to evaluate demographic, diagnostic and clinical characteristics associated with antidepressant receipt in FY07. Results: Approximately four out of ten (37.4%) received an antidepressant prescription of which 26.7% were incident prescriptions. SSRI or SNRI were the most common antidepressants prescribed. For both incidence and prevalence analyses, receipt of an antidepressant was significantly associated with co-occurring diagnoses of depression, PTSD, anxiety, schizoaffective disorder and receipt of care in specialty outpatient mental health clinic. Receipt of antidepressant was significantly less likely among those who were homeless compared to those who were housed. Discussion: Antidepressants are commonly prescribed among veterans with schizophrenia. Antidepressant receipt was associated with the use of specialty mental health care services and with concurrent clinical diagnoses for which antidepressant medication, in the absence of schizophrenia, are commonly prescribed. Further studies are needed to examine the reasons why clinicians prescribe antidepressant medications to persons with schizophrenia and whether the benefits associated with antidepressant use outweigh their health risks.