The Role of Selegiline in the Treatment of Negative Symptoms Associated with Schizophrenia

School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO 64108, USA.
Annals of Pharmacotherapy (Impact Factor: 2.06). 06/2007; 41(5):851-6. DOI: 10.1345/aph.1H556
Source: PubMed


To evaluate the role of selegiline in the treatment of negative symptoms associated with schizophrenia.
MEDLINE (1966-January 2007) and PsychINFO (1967-January 2007) were searched, using the terms schizophrenia, negative symptoms, and selegiline. A bibliographic search was conducted, as well.
All English-language articles identified from the search were evaluated. All primary literature was included in the review.
Based on its dopamine-enhancing property, selegiline has been studied as augmentation to antipsychotic therapy for the treatment of negative symptoms associated with schizophrenia. The efficacy of low-dose oral selegiline for the treatment of negative symptoms has been evaluated in 1 case report, 2 open-label trials, and 2 controlled trials. The case report and both open-label trials report improvement of negative symptoms associated with low-dose oral selegiline. In 1 of the controlled trials, selegiline showed no difference in effect from that of placebo. These data are limited by small sample sizes. The largest controlled trial demonstrated a statistically significant difference between selegiline and placebo; however, the clinical significance is questionable, given that patients treated with selegiline were still experiencing marked negative symptoms at study completion. No comparative studies evaluating low-dose oral selegiline versus other augmentative treatment options for negative symptoms associated with schizophrenia exist at this time.
Given the limitations of current literature, low-dose oral selegiline cannot be recommended for treatment of negative symptoms associated with schizophrenia. Additional controlled trials are needed to better delineate whether there is a role for selegiline in decreasing the burden of negative symptoms associated with schizophrenia.

Download full-text


Available from: Leigh Anne Nelson
  • [Show abstract] [Hide abstract]
    ABSTRACT: Schizophrenic patients at risk of suicide are more likely to be young, male, white, never married, with post-psychotic depression, and a history of substance abuse and suicide attempts. Hopelessness, social isolation, awareness of illness and hospitalization are also related to suicide risk. Deteriorating health with a high level of premorbid functioning, recent loss or rejection, limited external support, family stress or instability are other features that have been reported in schizophrenic patients who commit suicide. Atypical antipsychotics, especially clozapine, have emerged as important tools in the therapeutic armamentarium. Psychosocial intervention and psychotherapy may play an important role in the management of suicide risk, especially if such interventions help the patient face daily difficulties, loneliness and conflicts inside the family.
    No preview · Article · Feb 2008 · Expert Review of Neurotherapeutics
  • [Show abstract] [Hide abstract]
    ABSTRACT: It has been reported that selegiline, a Selective Monoamine Oxidase Inhibitor B (MAOI-B), at low doses would be helpful for treating negative symptoms in schizophrenia. Nevertheless, the results are contradictory so far. This study was designed to investigate the effect of selegiline added to risperidone as augmentation therapy in patients with chronic schizophrenia and prominent negative symptoms in an 8 week, double blind and randomized clinical trial. Eligible participants in this study were 40 patients with chronic schizophrenia. All patients were inpatients and were in the active phase of the illness, and met DSM-IV-TR criteria for schizophrenia. Patients were allocated in a random fashion, 20 to risperidone 6 mg/day plus selegiline 10 mg/day (5 mg bid) and 20 to risperidone 6 mg/day plus placebo. The principal measure of the outcome was Positive and Negative Syndrome Scale (PANSS). Although both protocols significantly decreased the score of the positive, negative, and general psychopathological symptoms over the trial period, the combination of risperidone and selegiline showed a significant superiority over risperidone alone in decreasing negative symptoms and PANSS total scores. The present study indicates selegiline as a potential adjunctive treatment strategy for the negative symptoms of schizophrenia. Nevertheless, results of larger controlled trials are needed before recommendation for a broad clinical application can be made.
    No preview · Article · Mar 2008 · Human Psychopharmacology Clinical and Experimental
  • [Show abstract] [Hide abstract]
    ABSTRACT: Suicidal behavior remains a major source of morbidity and mortality among schizophrenics. The National Institute of Mental Health Longitudinal Study of Chronic Schizophrenia found that over a mean of 6 years, 38% of the patients had at least one suicide attempt and 57% admitted to substantial suicidal ideation. Suicide is also a major issue among inpatients, with serious implications for clinical practice and patient-doctor relationships. The management of schizophrenic patients with suicide risk remains a difficult area for clinicians despite attempts to better understand it by gathering experts in the field. This article discusses the frequency of suicidal behavior in schizophrenia, offers a model for understanding it, and discusses various aspects of the management of the at-risk schizophrenic patient.
    No preview · Article · Dec 2009 · The Psychiatric clinics of North America
Show more