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Targeting the Immune System With Pharmacotherapy in Schizophrenia

  • Schizophrenia and Other Psychotic Disorders (J Csernansky, Section Editor)
  • Published:
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Opinion statement

The clinical manifestations of increased cytokine activity in individuals with schizophrenia have not been clearly delineated; thus, planning pharmacological interventions remains an entirely empirical endeavor. Although there are many preliminary findings regarding the use of adjunct pharmacotherapeutic strategies targeting the immune system, in most instances, clearly efficacious results require further validation. Antipsychotics remain the most effective pharmacological treatment approach in schizophrenia, and evidence suggests that they impact cytokine and immune cellular physiology in the patient, though this requires improved mechanistic understanding. Omega-3 polyunsaturated fatty acids (PUFAs) and statins may be a beneficial supplement in the situation where a patient with metabolic syndrome is a candidate for dietary modifications and/or control of LDL-cholesterol. Such an approach would require adjusting the diet and pharmacology towards a profile that could have antiinflammatory effects, especially considering that adiposity is a source of increased inflammatory activity. Another strategy would be the addition of the neurosteroid pregnenolone, which appears to be well tolerated. Non-steroidal antiinflammatory drugs (NSAIDS) are routinely prescribed for other clinical conditions; thus, their use in schizophrenia could be easily implemented; however, their efficacy is unclear, and side effects require careful monitoring. The use of tetracycline antibiotics such as minocycline or antiimmune drugs such as azathioprine or methotrexate should be left to an academic research group, where the outcome and molecular signatures can be monitored in a controlled manner. Ultimately, the benefit/risk ratio of each of these adjunct treatments should be considered on a case-by-case basis. Finally, lifestyle changes such as improved sleep, reduced smoking, and weight reduction strategies, all factors which are associated with increased inflammation, should not be overlooked when working towards an improved functional outcome.

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Acknowledgements

This work was supported in part by PHS grant (NIH) R01MH094358 (R.P.S.).

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Authors and Affiliations

  1. The Psychiatric Institute, University of Illinois at Chicago, 1601 W. Taylor St, Chicago, IL, 60612, USA

    Jennifer K. Melbourne MS, Benjamin Feiner BS, Cherise Rosen PhD & Rajiv P. Sharma MD

  2. Jesse Brown Veterans Affairs Medical Center, 820 South Damen Avenue (M/C 151), Chicago, IL, 60612, USA

    Rajiv P. Sharma MD

  3. Department of Psychiatry, Neuropsychiatric Institute, 912 S. Wood Street (M/C 913), Chicago, IL, 60612, USA

    Rajiv P. Sharma MD

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  1. Jennifer K. Melbourne MS
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Correspondence to Rajiv P. Sharma MD.

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Jennifer K. Melbourne declares that she has no conflict of interest. Benjamin Feiner declares that he has no conflict of interest. Cherise Rosen declares that she has no conflict of interest. Rajiv P. Sharma declares that he has no conflict of interest.

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All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki Declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

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This article is part of the Topical Collection on Schizophrenia and Other Psychotic Disorders

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Melbourne, J.K., Feiner, B., Rosen, C. et al. Targeting the Immune System With Pharmacotherapy in Schizophrenia. Curr Treat Options Psych 4, 139–151 (2017). https://doi.org/10.1007/s40501-017-0114-0

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