Depression Alert: Little Benefit, Some Harm from Adjunctive Antipsychotics

Small Benefit of Adjunctive Antipsychotics for Depression
Small Benefit of Adjunctive Antipsychotics for Depression

(HealthDay News) – Atypical antipsychotic drugs for the adjunctive treatment of depression are associated with relatively small benefits, no improvement in function or quality of life, and adverse events, according to research published online March 12 in PLOS Medicine.

Glen I. Spielmans, PhD, from the Metropolitan State University in St. Paul, MN, and colleagues performed a systematic review and meta-analysis of 14 short-term (4–12 weeks) randomized clinical trials with 3,549 participants that compared adjunctive antipsychotic medications to placebo to treat depression.

The researchers found that the likelihood of remission was significantly higher after treatment with aripiprazole (odds ratio [OR], 2.01), olanzapine plus fluoxetine (OR, 1.42), quetiapine (OR, 1.79), and risperidone (OR, 2.37). The number needed to treat was 19 for olanzapine plus fluoxetine and nine for all other drugs. All drugs except the combination significantly improved response rates. All four drugs reduced clinician-rated depression severity measures but had little effect on measures of functioning and quality of life and were linked to several adverse events.

"Atypical antipsychotic medications for the adjunctive treatment of depression are efficacious in reducing observer-rated depressive symptoms, but clinicians should interpret these findings cautiously in light of (1) the small-to-moderate-sized benefits, (2) the lack of benefit with regards to quality of life or functional impairment, and (3) the abundant evidence of potential treatment-related harm," Spielmans and colleagues conclude.

One author is involved in a trial of aripiprazole for resistant depression (with no funding from pharmaceutical companies) and is serving as a consultant in a lawsuit against the manufacturer of aripiprazole.

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