Differences between Depression and Negative Syndrome of Schizophrenia

The literature shows a very wide disparity in the frequency of both depression and the negative syndrome in schizophrenia (Patel et.al, 2015, Kirkpatrick et.al, 2006, An der Heiden, Leber, & Häfner, 2016, Foussias &Remington, 2010, Sonmez et.al, 2016). The current conclusion is that there is a wealth of similarity in the behavior in both conditions and therefore the investigators often confuse one disorder or set of symptoms (depressive vs. negative symptoms) with the other. The reason behind this seems to be that the various scales that were used in these studies do not sufficiently distinguish between the two disorders.

Below is a summary of the differences between the two disorders as I see it:

  • Mood/Feeling
    • Depression: Painful mood that may be intolerable
    • Negative Symptom: Apathy is the primary affect
  • Relationship to Unhappiness/Mood
    • Depression: Will do anything to get out of a depressive state (for example drug taking).
    • Negative Symptom: Generally indifferent to the state of apathy
  • Duration/ Pattern of Depressive States
    • Depression: States send to be episodic
    • Negative Symptom: Inertia persists often for rest of life.
  • Reaction to Medication
    • Depression: Some individuals are totally relieved by antidepressants.
    • Negative Symptom: Non-responsive to medication
  • Relation to Other People
    • Depression: Individuals turn to other people for sympathy, support, and help (except for autonomous personality)
    • Negative Symptom: Withdrawal from other people and social environments
  • Response to Stimulation
    • Depression:Minimal response to stimulationN.S.:Stimulation may cause full activation (hits the bulls-eye). Individual may go from inertia to full activation into the adaptive mode. Ex. Sings, dances, plays games.
  • Response to Reward
    • Depression: It has been demonstrated that these individuals only have a transient response to reward.
    • Negative Symptom: These individuals can show a total response
  • Underlying Theme
    • Depression: Irretrievable loss. Still invested in loss of bonding relationship.
    • Negative Symptom: Accepts loss of bonding and has withdrawn investment in it.
  • View of the Future
    • Depression: Future is hopeless.
    • Negative Symptom: Indifferent to the future.


  1. An der Heiden W, Leber A, Häfner H (2016) Negative symptoms and their association with depressive symptoms in the long-term course of schizophrenia. Eur Arch Psychiatry Clin Neurosci266(5):387–3962.
  2. Foussias, G., Remington, G., (2010) Negative Symptoms in Schizophrenia: Avolition and Occam’s Razor, Schizophrenia Bulletin,36(2), 359–369, https://doi.org/10.1093/schbul/sbn0943.
  3. Kirkpatrick,B., Fenton,W., Carpenter ,W., Marder , S., (2006) The NIMH-MATRICS Consensus Statement on Negative Symptoms. Schizophrenia Bulletinvol. 32 no. 2 pp. 214–219, doi:10.1093/schbul/sbj0534.
  4. Patel, R., Jayatilleke, N., Broadbent, M., et al (2015) Negative symptoms in schizophrenia: a study in a large clinical sample of patients using a novel automated method.BMJ Open, 2015;5:e007619, 1-9, doi: 10.1136/bmjopen-2015-0076195.
  5. Sönmez, N., Røssberg, J. I., Evensen, J., Barder, H. E., Haahr, U., ten Velden Hegelstad, W., Joa, I., Johannessen, J. O., Langeveld, H., Larsen, T. K., Melle, I., Opjordsmoen, S., Rund, B. R., Simonsen, E., Vaglum, P., McGlashan, T., and Friis, S. (2016) Depressive symptoms in first episode psychosis: a 10-year follow-up study. Early Intervention in Psychiatry, 10: 227–233. doi: 10.1111/eip.12163.