Comparative efficacy between clozapine and other atypical antipsychotics on depressive symptoms in patients with schizophrenia

Analysis of the CATIE phase 2E data

Shinichiro Nakajima, Hiroyoshi Takeuchi, Gagan Fervaha, Eric Plitman, Jun Ku Chung, Fernando Caravaggio, Yusuke Iwata, Yukiko Mihashi, Philip Gerretsen, Gary Remington, Benoit Mulsant, Ariel Graff-Guerrero

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: The comparative antidepressant effects of clozapine and other atypical antipsychotics for schizophrenia remain elusive, leading us to examine this question using the data from the Clinical Antipsychotic Trials of Intervention Effectiveness phase 2E. Methods: Ninety-nine patients who discontinued treatment with olanzapine, quetiapine, risperidone, or ziprasidone because of inadequate efficacy were randomly assigned to open-label treatment with clozapine (n = 49) or double-blind treatment with another atypical antipsychotic not previously received in the trial (olanzapine [n = 19], quetiapine [n = 15], or risperidone [n = 16]). The primary outcome was the Calgary Depression Scale for Schizophrenia (CDSS) total score. Antidepressant effects of clozapine and the other atypical antipsychotics were compared in patients with chronic schizophrenia and those with a major depressive episode (MDE) at baseline (i.e. ≥ 6 on the CDSS), using mixed models. Results: No differences in the baseline CDSS total scores were found between the treatment groups regardless of presence of an MDE. Clozapine was more effective than quetiapine in antidepressant effects for chronic schizophrenia (p < .01 for the whole sample and p = .01 for those with an MDE), and comparable to olanzapine and risperidone. Conclusion: The present findings suggest that clozapine demonstrates superior antidepressant effects to quetiapine and comparable effects to olanzapine and risperidone in chronic schizophrenia regardless of presence of MDE. Given the indication of clozapine for treatment-resistant schizophrenia (TRS) and the negative impacts of depressive symptoms on clinical outcomes in schizophrenia, further research is warranted to investigate antidepressant effects of clozapine in TRS with an MDE.

Original languageEnglish
Pages (from-to)429-433
Number of pages5
JournalSchizophrenia Research
Volume161
Issue number2-3
DOIs
Publication statusPublished - 2015 Feb 1

Fingerprint

Clozapine
Antipsychotic Agents
Schizophrenia
olanzapine
Depression
Risperidone
Antidepressive Agents
Therapeutics
Clinical Trials
Quetiapine Fumarate

Keywords

  • CATIE
  • Clozapine
  • Depression
  • Quetiapine
  • Schizophrenia

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry

Cite this

Comparative efficacy between clozapine and other atypical antipsychotics on depressive symptoms in patients with schizophrenia : Analysis of the CATIE phase 2E data. / Nakajima, Shinichiro; Takeuchi, Hiroyoshi; Fervaha, Gagan; Plitman, Eric; Chung, Jun Ku; Caravaggio, Fernando; Iwata, Yusuke; Mihashi, Yukiko; Gerretsen, Philip; Remington, Gary; Mulsant, Benoit; Graff-Guerrero, Ariel.

In: Schizophrenia Research, Vol. 161, No. 2-3, 01.02.2015, p. 429-433.

Research output: Contribution to journalArticle

Nakajima, S, Takeuchi, H, Fervaha, G, Plitman, E, Chung, JK, Caravaggio, F, Iwata, Y, Mihashi, Y, Gerretsen, P, Remington, G, Mulsant, B & Graff-Guerrero, A 2015, 'Comparative efficacy between clozapine and other atypical antipsychotics on depressive symptoms in patients with schizophrenia: Analysis of the CATIE phase 2E data', Schizophrenia Research, vol. 161, no. 2-3, pp. 429-433. https://doi.org/10.1016/j.schres.2014.12.024
Nakajima, Shinichiro ; Takeuchi, Hiroyoshi ; Fervaha, Gagan ; Plitman, Eric ; Chung, Jun Ku ; Caravaggio, Fernando ; Iwata, Yusuke ; Mihashi, Yukiko ; Gerretsen, Philip ; Remington, Gary ; Mulsant, Benoit ; Graff-Guerrero, Ariel. / Comparative efficacy between clozapine and other atypical antipsychotics on depressive symptoms in patients with schizophrenia : Analysis of the CATIE phase 2E data. In: Schizophrenia Research. 2015 ; Vol. 161, No. 2-3. pp. 429-433.
@article{9e65e3728b2b425b948b5b8fe121b203,
title = "Comparative efficacy between clozapine and other atypical antipsychotics on depressive symptoms in patients with schizophrenia: Analysis of the CATIE phase 2E data",
abstract = "Background: The comparative antidepressant effects of clozapine and other atypical antipsychotics for schizophrenia remain elusive, leading us to examine this question using the data from the Clinical Antipsychotic Trials of Intervention Effectiveness phase 2E. Methods: Ninety-nine patients who discontinued treatment with olanzapine, quetiapine, risperidone, or ziprasidone because of inadequate efficacy were randomly assigned to open-label treatment with clozapine (n = 49) or double-blind treatment with another atypical antipsychotic not previously received in the trial (olanzapine [n = 19], quetiapine [n = 15], or risperidone [n = 16]). The primary outcome was the Calgary Depression Scale for Schizophrenia (CDSS) total score. Antidepressant effects of clozapine and the other atypical antipsychotics were compared in patients with chronic schizophrenia and those with a major depressive episode (MDE) at baseline (i.e. ≥ 6 on the CDSS), using mixed models. Results: No differences in the baseline CDSS total scores were found between the treatment groups regardless of presence of an MDE. Clozapine was more effective than quetiapine in antidepressant effects for chronic schizophrenia (p < .01 for the whole sample and p = .01 for those with an MDE), and comparable to olanzapine and risperidone. Conclusion: The present findings suggest that clozapine demonstrates superior antidepressant effects to quetiapine and comparable effects to olanzapine and risperidone in chronic schizophrenia regardless of presence of MDE. Given the indication of clozapine for treatment-resistant schizophrenia (TRS) and the negative impacts of depressive symptoms on clinical outcomes in schizophrenia, further research is warranted to investigate antidepressant effects of clozapine in TRS with an MDE.",
keywords = "CATIE, Clozapine, Depression, Quetiapine, Schizophrenia",
author = "Shinichiro Nakajima and Hiroyoshi Takeuchi and Gagan Fervaha and Eric Plitman and Chung, {Jun Ku} and Fernando Caravaggio and Yusuke Iwata and Yukiko Mihashi and Philip Gerretsen and Gary Remington and Benoit Mulsant and Ariel Graff-Guerrero",
year = "2015",
month = "2",
day = "1",
doi = "10.1016/j.schres.2014.12.024",
language = "English",
volume = "161",
pages = "429--433",
journal = "Schizophrenia Research",
issn = "0920-9964",
publisher = "Elsevier",
number = "2-3",

}

TY - JOUR

T1 - Comparative efficacy between clozapine and other atypical antipsychotics on depressive symptoms in patients with schizophrenia

T2 - Analysis of the CATIE phase 2E data

AU - Nakajima, Shinichiro

AU - Takeuchi, Hiroyoshi

AU - Fervaha, Gagan

AU - Plitman, Eric

AU - Chung, Jun Ku

AU - Caravaggio, Fernando

AU - Iwata, Yusuke

AU - Mihashi, Yukiko

AU - Gerretsen, Philip

AU - Remington, Gary

AU - Mulsant, Benoit

AU - Graff-Guerrero, Ariel

PY - 2015/2/1

Y1 - 2015/2/1

N2 - Background: The comparative antidepressant effects of clozapine and other atypical antipsychotics for schizophrenia remain elusive, leading us to examine this question using the data from the Clinical Antipsychotic Trials of Intervention Effectiveness phase 2E. Methods: Ninety-nine patients who discontinued treatment with olanzapine, quetiapine, risperidone, or ziprasidone because of inadequate efficacy were randomly assigned to open-label treatment with clozapine (n = 49) or double-blind treatment with another atypical antipsychotic not previously received in the trial (olanzapine [n = 19], quetiapine [n = 15], or risperidone [n = 16]). The primary outcome was the Calgary Depression Scale for Schizophrenia (CDSS) total score. Antidepressant effects of clozapine and the other atypical antipsychotics were compared in patients with chronic schizophrenia and those with a major depressive episode (MDE) at baseline (i.e. ≥ 6 on the CDSS), using mixed models. Results: No differences in the baseline CDSS total scores were found between the treatment groups regardless of presence of an MDE. Clozapine was more effective than quetiapine in antidepressant effects for chronic schizophrenia (p < .01 for the whole sample and p = .01 for those with an MDE), and comparable to olanzapine and risperidone. Conclusion: The present findings suggest that clozapine demonstrates superior antidepressant effects to quetiapine and comparable effects to olanzapine and risperidone in chronic schizophrenia regardless of presence of MDE. Given the indication of clozapine for treatment-resistant schizophrenia (TRS) and the negative impacts of depressive symptoms on clinical outcomes in schizophrenia, further research is warranted to investigate antidepressant effects of clozapine in TRS with an MDE.

AB - Background: The comparative antidepressant effects of clozapine and other atypical antipsychotics for schizophrenia remain elusive, leading us to examine this question using the data from the Clinical Antipsychotic Trials of Intervention Effectiveness phase 2E. Methods: Ninety-nine patients who discontinued treatment with olanzapine, quetiapine, risperidone, or ziprasidone because of inadequate efficacy were randomly assigned to open-label treatment with clozapine (n = 49) or double-blind treatment with another atypical antipsychotic not previously received in the trial (olanzapine [n = 19], quetiapine [n = 15], or risperidone [n = 16]). The primary outcome was the Calgary Depression Scale for Schizophrenia (CDSS) total score. Antidepressant effects of clozapine and the other atypical antipsychotics were compared in patients with chronic schizophrenia and those with a major depressive episode (MDE) at baseline (i.e. ≥ 6 on the CDSS), using mixed models. Results: No differences in the baseline CDSS total scores were found between the treatment groups regardless of presence of an MDE. Clozapine was more effective than quetiapine in antidepressant effects for chronic schizophrenia (p < .01 for the whole sample and p = .01 for those with an MDE), and comparable to olanzapine and risperidone. Conclusion: The present findings suggest that clozapine demonstrates superior antidepressant effects to quetiapine and comparable effects to olanzapine and risperidone in chronic schizophrenia regardless of presence of MDE. Given the indication of clozapine for treatment-resistant schizophrenia (TRS) and the negative impacts of depressive symptoms on clinical outcomes in schizophrenia, further research is warranted to investigate antidepressant effects of clozapine in TRS with an MDE.

KW - CATIE

KW - Clozapine

KW - Depression

KW - Quetiapine

KW - Schizophrenia

UR - http://www.scopus.com/inward/record.url?scp=84921489342&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84921489342&partnerID=8YFLogxK

U2 - 10.1016/j.schres.2014.12.024

DO - 10.1016/j.schres.2014.12.024

M3 - Article

VL - 161

SP - 429

EP - 433

JO - Schizophrenia Research

JF - Schizophrenia Research

SN - 0920-9964

IS - 2-3

ER -