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Dr. Bob is Robert Hsiung, MD,
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Posted by Phillipa on March 19, 2013, at 21:19:47
Seems the use of atypical antipsychotics for major depression is more risk than benefit with almost no improvement noted. Phillipa
Medscape Medical News > Psychiatry'Unimpressive' Evidence Base for Antipsychotics in Depression
Megan Brooks
Mar 18, 2013
Adding an atypical antipsychotic to an antidepressant provides a small to moderate improvement in depressive symptoms in adults, new research suggests.
The meta-analysis also shows that the benefits of adjunctive antipsychotics in terms of quality of life and improved functioning are small to nonexistent, and according to investigators, there is "abundant evidence of potential treatment-related harm."
"The rapidly increasing use of atypical antipsychotics for treatment-resistant depression is based on a rather unimpressive evidence base," study author Glen Spielmans, PhD, associate professor, Department of Psychology, Metropolitan State University in St. Paul, Minnesota, who worked on the review, told Medscape Medical News.
"It is likely wise to carefully examine options linked to fewer adverse events before considering use of an atypical antipsychotic for treating depression," he added.
The study was published online March 12 in PLoS Medicine.
Small to Moderate Effect
For the analysis, the researchers identified 14 randomized controlled trials that compared adjunctive antipsychotic medications (aripiprazole, olanzapine/fluoxetine combination [OFC], quetiapine, or risperidone) to placebo in the treatment of depression unresponsive to antidepressant medication alone. The trials lasted from 4 to 12 weeks.
All 4 antipsychotics had statistically significant albeit small to moderate effects on remission, with odds ratios ranging from 1.42 to 2.37. Remission was usually defined as a score of less than 8 at the study end point on the Montgomery-Ǻsberg Depression Rating Scale. The researchers note that the number needed to treat (NNT) for 1 patient to achieve remission was 19 for OFC and 9 for all other drugs.
All of the antipsychotic medications except OFC also significantly improved response rates (defined as a 50% improvement in depression rating score), with odds ratios ranging from 1.53 to 2.07. The NNT for 1 patient to achieve a response was 7 with aripiprazole, 8 with risperidone, and 10 with quetiapine.
However, the medications provided little or no benefit in terms of functioning and quality of life, except for risperidone, which had a small to moderate effect on quality of life (Hedges g = 0.49).
Dr. Glen Spielmans
Adjunctive treatment with atypical antipsychotic medications was linked to several adverse effects, "although the drugs varied in their adverse event profiles somewhat," Dr. Spielmans said.
Common side effects included weight gain (for all 4 drugs), akathisia (with aripiprazole), sedation (with quetiapine, OFC, and aripiprazole), and abnormal metabolic laboratory results (with quetiapine and OFC).
The researchers say "shortcomings in study design and data reporting, as well as use of post hoc analyses, may have inflated the apparent benefits of treatment and reduced the apparent incidence of adverse events."
Dr. Spielmans pointed out that long-term efficacy and safety of these agents are "unknown" and that "no research has compared atypical antipsychotics to other options for treatment-resistant depression, such as switching antidepressants or adding psychotherapy."
Uncertain Risk-Benefit Ratio
"It's just not certain that these drugs have a favorable benefit-to-risk profile, and they really do need to be compared against other existing standards and alternatives," Michael Thase, MD, professor of psychiatry at the University of Pennsylvania Perelman School of Medicine in Philadelphia, who was not involved in the study, told Medscape Medical News.
The results of this new meta-analysis basically show that the benefits of these antipsychotics for depression are "modest and that each of these drugs has particular tolerability that are fairly clear," Dr. Thase added.
Information from Industry
He also noted that this new meta-analysis has a "somewhat more cautionary, less upbeat spin" on this topic than 2 prior meta-analyses (Nelson et al, Am J Psychiatry 2009;166:980-991, and Papakostas et al, J Clin Psychiatry 2007;68:826-831). He said the basic findings of the 3 meta-analyses are "pretty much the same; the major difference is interpretive."
At the end of the day, clinicians "are very careful and should be very careful in using these medications," Dr. Thase said.
Dr. Spielmans is a member of Healthy Skepticism and holds shares of less than $10,000 in a mutual fund (Vanguard Health Care) that invests in pharmaceutical firms. A complete list of author disclosures is given in the article. Dr. Thase has disclosed no relevant financial relationships.PLoS Med. Published online March 2013
Posted by Emme_V2 on March 22, 2013, at 6:46:39
In reply to Unimpressive Results For Atyp Antip In Depression, posted by Phillipa on March 19, 2013, at 21:19:47
I don't have the time right now to delve into this study, but anecdotes don't always mesh with the pronouncements of the authors of studies. I may be an "n" of one, but Abilify in combination with a couple of other things is extremely effective for my depression. It was the ingredient that turned things around for a long time.
Posted by Phillipa on March 22, 2013, at 18:41:42
In reply to Re: Unimpressive Results For Atyp Antip In Depression » Phillipa, posted by Emme_V2 on March 22, 2013, at 6:46:39
Don't forget I didn't write it just delivering the news I receive from RN & doc newsletter. Phillipa
Posted by Emme_V2 on March 23, 2013, at 6:24:32
In reply to Re: Unimpressive Results For Atyp Antip In Depression » Emme_V2, posted by Phillipa on March 22, 2013, at 18:41:42
I know you didn't write it. But you obviously thought it was important enough to post it.
Posted by Phillipa on March 23, 2013, at 10:06:30
In reply to Re: Unimpressive Results For Atyp Antip In Depression » Phillipa, posted by Emme_V2 on March 23, 2013, at 6:24:32
Knowledge is power. So all types of articles are information. Since you read it I guess you also did. I just post what my nursing newsletter feels is important. I don't post all they send too many topics. Phillipa
Posted by jono_in_adelaide on March 24, 2013, at 18:48:20
In reply to Re: Unimpressive Results For Atyp Antip In Depression » Emme_V2, posted by Phillipa on March 23, 2013, at 10:06:30
"a small to moderate improvement "
A moderate improvement is well worth having IMHO, adding risperidone 1mg at night to my antidepressants gave a modest improvement which made a good difference to how i was feeling/doing
I think its likely that some people get little benifit, some get moderate benifit and a few get a lot of benifit - but the only way to find out is try them on the individual.
People are individuals, not statistical averages
Posted by Phillipa on March 24, 2013, at 20:50:40
In reply to Re: Unimpressive Results For Atyp Antip In Depression, posted by jono_in_adelaide on March 24, 2013, at 18:48:20
Jono welcome back. Hope it was great!!!! Phillipa
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