Escitalopram augmentation improves negative symptoms of treatment resistant schizophrenia patients - A randomized controlled trial

Serum interleukin (IL)-6 levels in schizophrenia correlate with the severity of negative symptoms. This study aimed to explore the potential immune mechanism of SSRI augmentation in the management of patients with treatment-resistant schizophrenia, assessing changes in IL-6 and CRP amounts. This was a randomized double-blind, placebo-controlled, 8-week study of escitalopram augmentation in 62 schizophrenic patients treated in 2016-2017 at the Shandong Mental Health Center. Twenty-nine healthy controls were also included. Patients received add-on escitalopram or placebo for 8 weeks. Serum IL-6 and CRP were measured at baseline and 8 weeks. The primary outcome was the Positive and Negative Syndrome Scale (PANSS). After 8 weeks of treatment, reductions in total PANSS, negative subscore, and affective subscore were more important in escitalopram treated patients than in the placebo group (all P < 0.05). Escitalopram significantly decreased CRP and IL-6 levels (both P < 0.05). At baseline, IL-6's effects on negative and cognitive symptoms represented 16.2% and 20.1%, respectively; at week 8, these effects were 22.7% and 20.8% on negative and cognitive symptoms, respectively. CRP had no impact on any PANSS score. Overall, escitalopram augmentation may be a useful addition for schizophrenic patients with persistent negative symptoms. Changes in IL-6 may be associated with negative and cognitive symptoms.