Roger Mulder1,2, Amber Hamilton1,3,4,5, Lauren Irwin1,3,4,5, Philip Boyce1,6, Grace Morris1,3,4,5, Richard J Porter1,2, Gin S Malhi1,3,4,5. 1. Sophisticated Mood Appraisal & Refinement of Treatment (SMART) Group. 2. Department of Psychological Medicine, University of Otago-Christchurch, Christchurch, New Zealand. 3. Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia. 4. Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia. 5. CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia. 6. Discipline of Psychiatry, Sydney Medical School, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.
Abstract
OBJECTIVES: To evaluate the efficacy and safety of using adjunctive antipsychotics in patients with major depressive disorder. METHOD: Studies published since the last Cochrane review conducted in 2010 were identified via a literature search of recognised databases, using the keywords "adjunct*", "augment*", "antipsychotic" and "depression", and systematically evaluated. A targeted review of relevant guidelines was undertaken. RESULTS: Adjunctive antipsychotics produce a small but significant improvement in depressive symptoms in most studies. Most of the studies focussed on patients with an inadequate response to antidepressants rather than patients with treatment resistant depression. Treatment guidelines were variable but generally supported the use of adjunctive antipsychotics while cautioning about the risk of side effects. Most were non-specific about the length of time adjunctive antipsychotics should be prescribed. CONCLUSIONS: The studies do not support the routine use of adjunctive antipsychotics in patients with an inadequate response to antidepressants. They may be beneficial when used short-term in patients with treatment resistant depression who have specific symptoms (severe ruminations, melancholia, major sleep disturbance) that appear to respond well to adjunctive antipsychotics. There is no support for long-term use. Research should focus on specifying which symptom profiles are responsive and how adjunctive antipsychotics compare to other strategies in treatment resistant depression.
OBJECTIVES: To evaluate the efficacy and safety of using adjunctive antipsychotics in patients with major depressive disorder. METHOD: Studies published since the last Cochrane review conducted in 2010 were identified via a literature search of recognised databases, using the keywords "adjunct*", "augment*", "antipsychotic" and "depression", and systematically evaluated. A targeted review of relevant guidelines was undertaken. RESULTS: Adjunctive antipsychotics produce a small but significant improvement in depressive symptoms in most studies. Most of the studies focussed on patients with an inadequate response to antidepressants rather than patients with treatment resistant depression. Treatment guidelines were variable but generally supported the use of adjunctive antipsychotics while cautioning about the risk of side effects. Most were non-specific about the length of time adjunctive antipsychotics should be prescribed. CONCLUSIONS: The studies do not support the routine use of adjunctive antipsychotics in patients with an inadequate response to antidepressants. They may be beneficial when used short-term in patients with treatment resistant depression who have specific symptoms (severe ruminations, melancholia, major sleep disturbance) that appear to respond well to adjunctive antipsychotics. There is no support for long-term use. Research should focus on specifying which symptom profiles are responsive and how adjunctive antipsychotics compare to other strategies in treatment resistant depression.
Authors: Rakesh Jain; Sara Higa; Katelyn Keyloun; Julie Park; Machaon Bonafede; Amy Tung; Patrick Gillard; Andrew J Cutler Journal: Drugs Real World Outcomes Date: 2022-06-30