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Augmentation with Atypical Antipsychotics for Treatment-Resistant Depression
Filippo Cantù1, Valentina Ciappolino2, Paolo Enrico1
1Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy.
Journal of Affective Disorders
|November 17, 2020
Summary
Second-generation antipsychotics (SGAs) show promise in treating treatment-resistant depression (TRD). Aripiprazole and quetiapine are particularly effective add-on therapies for TRD, though larger studies are needed.
Area of Science:
- Psychiatry
- Pharmacology
Background:
- Treatment-resistant depression (TRD) is a significant clinical challenge, often leading to severe functional impairment and suicidal ideation.
- Second-generation antipsychotics (SGAs) are increasingly recognized for their potential in managing TRD.
Purpose of the Study:
- To systematically review randomized clinical trials (RCTs) evaluating the efficacy of SGAs as adjunctive therapy for treatment-resistant depression.
- To synthesize evidence on the effectiveness of specific SGAs in TRD management.
Main Methods:
- A comprehensive literature search was conducted across PubMed, Medline, and PsychINFO for RCTs published between January 2000 and March 2020.
- Sixteen RCTs met the inclusion criteria for the review.
Main Results:
- Add-on therapy with aripiprazole demonstrated benefits in TRD treatment.
- Quetiapine augmentation showed efficacy, particularly for TRD with comorbid anxiety or insomnia.
- Risperidone and olanzapine exhibited preliminary efficacy compared to placebo, suggesting potential therapeutic roles.
Conclusions:
- Augmentation with SGAs, especially aripiprazole and quetiapine, represents a viable therapeutic strategy for TRD.
- Limitations include inconsistent TRD definitions, small sample sizes, and heterogeneous drug dosages across studies.
- Larger, more homogeneous RCTs are necessary to strengthen evidence and improve therapeutic outcomes for TRD patients.
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