Augmentation of standard antidepressants with atypical antipsychotic agents for treatment-resistant major depressive disorder

Treatment-resistant depression (TRD) is not uncommon; 29% to 46% of patients with depression who are treated with antidepressants fail to respond fully. Dr. Papakostas discusses various augmentation strategies, focusing particular on a possible role for the newer atypical antipsychotics. Their complex neuropharmacological actions suggest such efficacy. One chart review and a number of open-label studies have been encouraging, but 2 double-blind, placebo controlled-studies have offered contradictory results. Considering the side-effect profiles of these drugs, a careful risk/benefit assessment is always required. While routinely used for psychotic depression and panic reactions in depressive disorders, their value as augmenters in TRD awaits further study.