It is not uncommon for people with schizophrenia to also have other psychiatric disorders. These disorders often include anxiety, substance abuse disorders and depression. With regards to depression, some researchers have estimated that it afflicts at least 50% of schizophrenic patients 1 2. Unfortunately, even though depression is very common in schizophrenia, it doesn’t always get recognized. As a result, it isn’t always treated.
When a person with schizophrenia also battles depression, it adds to his/her suffering and further undermines his/her overall quality of life. It affects his/her overall ability to function well. Schizophrenics who have depression are more likely to have a relapse with regards to psychotic episodes. They also have more hospitalizations and are less likely to follow through with prescribed treatment.
But depression may increase the schizophrenic person’s risk for suicide, which is already high. In fact, an estimated one out of 10 schizophrenic individuals will commit suicide 2. Compared to individuals who have clinical depression only, a person with schizophrenia is 3 times as likely to make a suicide attempt, and with a more lethal method as well 2.
Depression versus other factors in schizophrenia
Sometimes it is difficult to make a clear distinction between the “negative” symptoms of schizophrenia and clinical depression. Negative symptoms refer to things such as social withdrawal, low motivation and energy levels, difficulties or inability to feel pleasure, lack of interest in most things, and impaired thought processes. Many of these symptoms are typical of major depressive disorder as well.
Also, the antipsychotic medications used to treat schizophrenia may produce side effects which are very similar to depressive symptoms. These side effects may include limited spontaneity in the person’s speech and movements, restlessness, and a negative mood.
Since schizophrenic individuals’ thinking, perceptual experiences and communication skills may be impaired as a result of the schizophrenia itself, a treatment provider may have a difficult time detecting the depression and gauging their risk for suicide. There is some disagreement as to whether sadness is a good indicator of the presence of depression in schizophrenia.
Other possible indicators, which are all part of clinical depression, include feelings of hopelessness or worthlessness, a strong sense of helplessness, or excessive guilt. Suicidal ideation which is not due to psychosis (e.g., voices telling the person to kill him/herself) is also a potential indicator of comorbid depression.
written by Dr. Cheryl Lane, PsyD
References
- Psychiatric Comorbidities and Schizophrenia
- Depression and Suicide in Schizophrenia
