Monday, 6 May 2013

Antipsychotics Not the Answer for Treatment Resistant Depression

PLOS Med 2013; 10(3): e1001403

The so called atypical antipsychotics are no more effective than the older ones but the neuromuscular adverse effects have been replaced by metabolic ones.

One exception to this broad generalization is their use as an adjunctive treatment for treating depression, although there is a suspicion that this is a sign of “indication creep” for drugs which may be coming off patent. To address this, a systematic review raises its head in the March PLOS Medicine on-line Journal.

The authors identified 14 trials (all funded by drug manufacturers) where patients with depression who were “treatment resistant” were randomized to receive either an antipsycotic or placebo. The trials were short term studies ranging from 4 to 12 weeks and included aripriprazole, an olanzapine/fluoxetine combination, quetiapine and risperidone.

All four drugs had significant effects on remission and response (except the olanzapine/fluoxetine combination which did not affect response rates). However the effect was small with a mean difference of about 2.5 on the Montgomery-Asberg Depression Rating Scale. Additionally, on measures of quality of life the drugs had no or very small effect (with the exception of risperidone which had a small to moderate effect). Numbers needed to treat for remission compared to placebo were 9 for aripiprazole, quetiapine and risperidone and 19 for the olanzapine/fluoxetine combination.

Treatment was associated with weight gain, akathisia, sedation and abnormal metabolic laboratory results.

So would I have an antipsychotic if I had treatment resistant depression? Probably not and if I did I'd want to stop it pretty quickly.

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