OBJECTIVE: To examine the efficacy and overall tolerability of augmentation of standard antidepressants with atypical antipsychotic agents for treatment-resistant major depressive disorder. DATA SOURCES: MEDLINE/PubMed, EMBASE, the Cochrane database, and program syllabi from major psychiatric meetings held since 2000 as well as a number of online clinical trial results registries were searched. Makers of atypical anti-psychotic agents who do not maintain an online clinical study results registry were contacted directly. STUDY SELECTION: Double-blind, randomized, placebo-controlled clinical trials assessing adjunctive treatment of standard antidepressants with an atypical antipsychotic agent for treatment-resistant major depressive disorder were identified. DATA EXTRACTION: Data were extracted with the use of a pre-coded form. DATA SYNTHESIS: Data from 10 clinical trial reports involving a total of 1500 outpatients with treatment-resistant major depressive disorder were identified and combined using a random-effects model. Patients randomized to adjunctive treatment with an atypical antipsychotic agent were more likely to experience remission (risk ratio [RR] = 1.75, p < .0001) or clinical response (RR = 1.35, p = .001) than patients who received adjunctive placebo. Pooled remission and response rates for the 2 treatment groups were 47.4% vs. 22.3% and 57.2% vs. 35.4%, respectively. Although there was no difference in overall discontinuation rates (p = .929) or the rate of discontinuation due to inefficacy (p = .133) between the 2 treatment groups, the rate of discontinuation due to adverse events was lower among placebo-treated patients (RR = 3.38, p < .0001). CONCLUSIONS: These results support the utility of augmenting standard antidepressants with atypical antipsychotic agents for treatment-resistant major depressive disorder. An obvious limitation of this work is the absence of data focusing on the use of aripiprazole and ziprasidone. Future short- as well as long-term studies comparing the efficacy, safety, and tolerability of this versus other adjunctive strategies are warranted.
OBJECTIVE: To examine the efficacy and overall tolerability of augmentation of standard antidepressants with atypical antipsychotic agents for treatment-resistant major depressive disorder. DATA SOURCES: MEDLINE/PubMed, EMBASE, the Cochrane database, and program syllabi from major psychiatric meetings held since 2000 as well as a number of online clinical trial results registries were searched. Makers of atypical anti-psychotic agents who do not maintain an online clinical study results registry were contacted directly. STUDY SELECTION: Double-blind, randomized, placebo-controlled clinical trials assessing adjunctive treatment of standard antidepressants with an atypical antipsychotic agent for treatment-resistant major depressive disorder were identified. DATA EXTRACTION: Data were extracted with the use of a pre-coded form. DATA SYNTHESIS: Data from 10 clinical trial reports involving a total of 1500 outpatients with treatment-resistant major depressive disorder were identified and combined using a random-effects model. Patients randomized to adjunctive treatment with an atypical antipsychotic agent were more likely to experience remission (risk ratio [RR] = 1.75, p < .0001) or clinical response (RR = 1.35, p = .001) than patients who received adjunctive placebo. Pooled remission and response rates for the 2 treatment groups were 47.4% vs. 22.3% and 57.2% vs. 35.4%, respectively. Although there was no difference in overall discontinuation rates (p = .929) or the rate of discontinuation due to inefficacy (p = .133) between the 2 treatment groups, the rate of discontinuation due to adverse events was lower among placebo-treated patients (RR = 3.38, p < .0001). CONCLUSIONS: These results support the utility of augmenting standard antidepressants with atypical antipsychotic agents for treatment-resistant major depressive disorder. An obvious limitation of this work is the absence of data focusing on the use of aripiprazole and ziprasidone. Future short- as well as long-term studies comparing the efficacy, safety, and tolerability of this versus other adjunctive strategies are warranted.
Authors: Laura E Dichtel; Linda L Carpenter; Maren Nyer; David Mischoulon; Allison Kimball; Thilo Deckersbach; Darin D Dougherty; David A Schoenfeld; Lauren Fisher; Cristina Cusin; Christina Dording; Nhi-Ha Trinh; Paola Pedrelli; Albert Yeung; Amy Farabaugh; George I Papakostas; Trina Chang; Benjamin G Shapero; Justin Chen; Paolo Cassano; Emily M Hahn; Elizabeth M Rao; Roscoe O Brady; Ravinder J Singh; Audrey R Tyrka; Lawrence H Price; Maurizio Fava; Karen K Miller Journal: Am J Psychiatry Date: 2020-07-14 Impact factor: 18.112
Authors: Meera Sheffrin; Henry C Driscoll; Eric J Lenze; Benoit H Mulsant; Bruce G Pollock; Mark D Miller; Meryl A Butters; Mary Amanda Dew; Charles F Reynolds Journal: J Clin Psychiatry Date: 2009-02-10 Impact factor: 4.384
Authors: Michael E Thase; Madhukar H Trivedi; J Craig Nelson; Maurizio Fava; Rene Swanink; Quynh-Van Tran; Andrei Pikalov; Huyuan Yang; Berit X Carlson; Ronald N Marcus; Robert M Berman Journal: Prim Care Companion J Clin Psychiatry Date: 2008
Authors: Gabor I Keitner; Steven J Garlow; Christine E Ryan; Philip T Ninan; David A Solomon; Charles B Nemeroff; Martin B Keller Journal: J Psychiatr Res Date: 2008-06-30 Impact factor: 4.791
Authors: Walid F Gellad; Sherrie L Aspinall; Steven M Handler; Roslyn A Stone; Nicholas Castle; Todd P Semla; Chester B Good; Michael J Fine; Maurice Dysken; Joseph T Hanlon Journal: Med Care Date: 2012-11 Impact factor: 2.983