The Causality of Depression in Schizophrenia

The phenomenon of post-treatment depression in schizophrenia has become the subject of considerable controversy regarding its causality (Ananth and Chadirian, 1980; McGlashan and Carpenter, 1976a). But as the recent commentary by Hirsch (1982) emphasizes, the most controversial issue is focused on whether this depression is neuroleptic-induced. Hirsch himself refutes neuroleptic-induction on the basis of various uncontrolled data which seem ostensibly incompatible with this causality. Results indicating that pretreatment depressions appear in a high proportion of recently hospitalized schizophrenics, occur in drug-free patients, and frequently remit or decrease following neuroleptic therapy are cited as evidence contradicting neuroleptic-induction. Hirsch therefore proposes an alternative view: that this post-treatment depression is an integral, “revealed” aspect of the schizophrenia syndrome which arises from the same pathophysiological process (cf. McGlashan and Carpenter, 1976b).