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Do antidepressants prevent transition to psychosis in individuals at clinical high-risk (CHR-P)? Systematic review and meta-analysis

Published online by Cambridge University Press:  03 June 2022

Andrea Raballo Open the ORCID record for Andrea Raballo [Opens in a new window] ,
Michele Poletti Open the ORCID record for Michele Poletti [Opens in a new window]  and
Antonio Preti Open the ORCID record for Antonio Preti [Opens in a new window]
Andrea Raballo*
Affiliation:
Section of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Perugia, Italy Center for Translational, Phenomenological and Developmental Psychopathology (CTPDP), Perugia University Hospital, Perugia, Italy
Michele Poletti
Affiliation:
Department of Mental Health and Pathological Addiction, Child and Adolescent Neuropsychiatry Service, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
Antonio Preti
Affiliation:
Department of Neuroscience, University of Turin, Turin, Italy
*
Author for correspondence: Andrea Raballo, E-mail: andrea.raballo@unipg.it
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Abstract

Background

Emerging meta-analytical evidence indicates that baseline exposure to antipsychotics in individuals at clinical high-risk for psychosis (CHR-P) is associated with a higher risk of an imminent transition to psychosis. Despite their tolerability profile and potential beneficial effects, baseline exposure to antidepressants (AD) in CHR-P has surprisingly received far less attention as a potential risk modulator for transition to psychosis. The current systematic review and meta-analysis were performed to fix such a knowledge gap.

Methods

Systematic scrutiny of Medline and Cochrane library, performed up to 1 August 2021, searching for English-language studies on CHR-P reporting numeric data about the sample, the transition outcome at a predefined follow-up time and raw data on AD baseline exposure in relation to such outcome.

Results

Of 1942 identified records, 16 studies were included in the systematic review and meta-analysis. 26% of the participants were already exposed to AD at baseline; at the end of the follow-up 13.5% (95% CI 10.2–17.1%) of them (n = 448) transitioned to psychosis against 21.0% (18.9 to 23.3%) of non-AD exposed CHR-P (n = 1371). CHR-P participants who were already under AD treatment at baseline had a lower risk of transition than non-AD exposed CHR-P. The RR was 0.71 (95% CI 0.56–0.90) in the fixed-effects model (z = −2.79; p = 0.005), and 0.78 (0.58–1.05) in the random-effects model (z = −1.77; p = 0.096; tau-squared = 0.059). There was no relevant heterogeneity (Cochran's Q = 18.45; df = 15; p = 0.239; I2 = 18.7%).

Conclusions

Ongoing AD exposure at inception in CHR-P is associated to a reduced risk of transition to psychosis at follow up.

Keywords

Antidepressantantipsychoticsclinical high riskmeta-analysispsychosistransition
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 10 , July 2023 , pp. 4550 - 4560
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Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press

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