OBJECTIVE: It remains unclear whether unipolar psychotic depression should be treated with an antidepressant and an antipsychotic or with an antidepressant alone. METHOD: In a multi-center RCT, 122 patients (18-65 years) with DSM-IV-TR psychotic major depression and HAM-D-17 > or = 18 were randomized to 7 weeks imipramine (plasma-levels 200-300 microg/l), venlafaxine (375 mg/day) or venlafaxine-quetiapine (375 mg/day, 600 mg/day). Primary outcome was response on HAM-D-17. Secondary outcomes were response on CGI and remission (HAM-D-17). RESULTS:Venlafaxine-quetiapine was more effective than venlafaxine with no significant differences between venlafaxine-quetiapine and imipramine, or between imipramine and venlafaxine. Secondary outcomes followed the same pattern. CONCLUSION: That unipolar psychotic depression should be treated with a combination of an antidepressant and an antipsychotic and not with an antidepressant alone, can be considered evidence based with regard to venlafaxine-quetiapine vs. venlafaxine monotherapy. Whether this is also the case for imipramine monotherapy is likely, but cannot be concluded from the data.
RCT Entities:
OBJECTIVE: It remains unclear whether unipolar psychotic depression should be treated with an antidepressant and an antipsychotic or with an antidepressant alone. METHOD: In a multi-center RCT, 122 patients (18-65 years) with DSM-IV-TR psychotic major depression and HAM-D-17 > or = 18 were randomized to 7 weeks imipramine (plasma-levels 200-300 microg/l), venlafaxine (375 mg/day) or venlafaxine-quetiapine (375 mg/day, 600 mg/day). Primary outcome was response on HAM-D-17. Secondary outcomes were response on CGI and remission (HAM-D-17). RESULTS:Venlafaxine-quetiapine was more effective than venlafaxine with no significant differences between venlafaxine-quetiapine and imipramine, or between imipramine and venlafaxine. Secondary outcomes followed the same pattern. CONCLUSION: That unipolar psychotic depression should be treated with a combination of an antidepressant and an antipsychotic and not with an antidepressant alone, can be considered evidence based with regard to venlafaxine-quetiapine vs. venlafaxine monotherapy. Whether this is also the case for imipramine monotherapy is likely, but cannot be concluded from the data.
Authors: Alastair J Flint; Barnett S Meyers; Anthony J Rothschild; Ellen M Whyte; George S Alexopoulos; Matthew V Rudorfer; Patricia Marino; Samprit Banerjee; Cristina D Pollari; Yiyuan Wu; Aristotle N Voineskos; Benoit H Mulsant Journal: JAMA Date: 2019-08-20 Impact factor: 56.272
Authors: S D Østergaard; B S Meyers; A J Flint; B H Mulsant; E M Whyte; C M Ulbricht; P Bech; A J Rothschild Journal: Acta Psychiatr Scand Date: 2013-06-25 Impact factor: 6.392
Authors: S D Østergaard; A J Rothschild; A J Flint; B H Mulsant; E M Whyte; A K Leadholm; P Bech; B S Meyers Journal: Acta Psychiatr Scand Date: 2015-05-27 Impact factor: 6.392
Authors: Søren D Østergaard; Barnett S Meyers; Alastair J Flint; Benoit H Mulsant; Ellen M Whyte; Christine M Ulbricht; Per Bech; Anthony J Rothschild Journal: J Affect Disord Date: 2014-01-02 Impact factor: 4.839
Authors: Kristina M Deligiannidis; Anthony J Rothschild; Bruce A Barton; Aimee R Kroll-Desrosiers; Barnett S Meyers; Alastair J Flint; Ellen M Whyte; Benoit H Mulsant Journal: J Clin Psychiatry Date: 2013-10 Impact factor: 4.384
Authors: Alastair J Flint; Anthony J Rothschild; Ellen M Whyte; George S Alexopoulos; Benoit H Mulsant; Patricia Marino; Samprit Banerjee; Cristina D Pollari; Yiyuan Wu; Aristotle N Voineskos; Barnett S Meyers Journal: Am J Geriatr Psychiatry Date: 2020-11-15 Impact factor: 7.996