Use of adjunctive antipsychotic medications in depression

A study published this week in PLOS Medicine finds that while antipsychotic medications are associated with small-to-moderate improvements in depressive symptoms in adults, there is little evidence for improvement on measures of quality of life and these medications are linked to adverse events such as weight gain and sedation.

The results of the study, conducted by Glen Spielmans of Metropolitan State University in St. Paul, Minnesota and colleagues, have potential implications for the treatment of depression by providing clinicians with a better understanding of the risk–benefit profiles for commonly prescribed .

The authors reached these conclusions by combining the results from 14 published or unpublished randomized clinical trials (duration 4-12 weeks) comparing an adjunctive antipsychotic medication (, /fluoxetine combination [OFC], , or ) to placebo in the treatment of depression that had not responded to antidepressant medication alone.

The four medications showed statistically significant small or small-to-moderate beneficial effects on . However, on measures of functioning and quality of life, these medications generally produced either no benefit or small benefits. In addition, treatment was linked to several adverse events, such as akathisia, sedation, abnormal metabolic laboratory results, and weight gain. The authors also comment that shortcomings in study design and reporting may have over-emphasized the apparent benefits of treatment and reduced the apparent incidence of adverse events.

The authors say: "Taken together, our meta-analysis found evidence of (1) some improvement in clinician-assessed depressive symptoms, (2) little evidence of substantial benefit in overall well-being, and (3) abundant evidence of potential treatment-related harm."

They add: "Our comprehensive evaluation of safety and both relative and absolute efficacy provides critical insight that may be useful for clinicians attempting to thoroughly understand the risk–benefit profiles of these adjunctive treatments for major depressive disorder."

Individuals treated with adjunctive antipsychotic medication who are concerned about potential side effects are urged to discuss this study with their physician before making any decisions to stop taking or change any medications.

More information: Spielmans GI, Berman MI, Linardatos E, Rosenlicht NZ, Perry A, et al. (2013) Adjunctive Atypical Antipsychotic Treatment for Major Depressive Disorder: A Meta-Analysis of Depression, Quality of Life, and Safety Outcomes. PLoS Med 10(3): e1001403. doi:10.1371/journal.pmed.1001403

add to favorites email to friend print save as pdf

Related Stories

Recommended for you

Could summer camp be the key to world peace?

14 hours ago

According to findings from a new study by University of Chicago Booth School of Business Professor Jane Risen, and Chicago Booth doctoral student Juliana Schroeder, it may at least be a start.

Gender disparities in cognition will not diminish

Jul 28, 2014

The study, published in the Proceedings of the National Academy of Science, investigated the extent to which improvements in living conditions and educational opportunities over a person's life affect cognitive abilities and th ...

Facial features are the key to first impressions

Jul 28, 2014

A new study by researchers in the Department of Psychology at the University of York shows that it is possible to accurately predict first impressions using measurements of physical features in everyday images of faces, such ...

User comments