Atypical Antipsychotics Augmentation for Treatment-Resistant Depression.

A Systematic Review and Network Meta-Analysis conducted by Peng Xie et al. investigated the comparative efficacy and tolerability of adjunctive atypical antipsychotics for treatment-resistant depression. This post will summarize the clinical findings of this study.

ATYPICAL ANTIPSYCHOTICS INCLUDED:

18 randomized controlled trials were included with following seven different types (and dosages) of atypical antipsychotic agents:

  • standard-dose aripiprazole (n = 746)
  • low-dose aripiprazole (n = 253)
  • standard-dose olanzapine/fluoxetine (OFC, n = 599)
  • low-dose OFC (n = 59)
  • quetiapine (mean 250–350mg daily, n = 345)
  • quetiapine (mean 150–250mg daily, n = 344)
  • standard-dose risperidone (n = 217)

Note: low dose was defined as less than half the defined dose by the FDA-approved indications.

EFFICACY:

All standard-dose agents were significantly more effective compared with placebo, EXCEPT FOR low-dose OFC and low-dose aripiprazole.

(* LOW DOSES ANTIPSYCHOTICS NOT FOUND EFFICACIOUS).

SIDE-EFFECT DISCONTINUATIONS:

(1) All standard-dose agents had significantly more side-effect discontinuations than placebo, EXCEPT FOR risperidone.

(2) Quetiapine (mean dose 250–350 mg daily) and standard-dose OFC had significantly more side-effect discontinuations than low-dose OFC.

(3) Only quetiapine (mean dose 250–350mg daily) had a significantly higher rate of all-cause discontinuation than placebo.

(MEDICATION OF CHOICE IN THIS CLASS: RISPERIDONE).

QUALITY OF LIFE:

(1) In terms of the Quality of life/functioning outcome: only standard-dose risperidone and standard-dose aripiprazole were significantly more beneficial than placebo.

(2) Standard-dose risperidone was significantly more beneficial than quetiapine.

(MEDICATION OF CHOICE IN THIS CLASS: STANDARD DOSE RISPERIDONE & STANDARD DOSE ARIPIPRAZOLE)


According to this Systematic Review and Network Meta-Analysis: standard-dose risperidone appeared to be the most beneficial in balancing efficacy, tolerability, and quality of life. 


SOURCE:

  • Int J Neuropsychopharmacol. 2015 Oct; 18(11): pyv060.

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Dr. Harvinder Singh, M.D. (Admin)


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