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Augmentation of phenelzine with aripiprazole and quetiapine in a treatment-resistant patient with psychotic unipolar depression: case report and literature review

Published online by Cambridge University Press:  22 December 2016

Jonathan M. Meyer ,
Michael A. Cummings  and
George Proctor
Jonathan M. Meyer*
Affiliation:
California Department of State Hospitals, Psychopharmacology Resource Network, Department of State Hospitals–Patton, Patton, California 92369, USA
Michael A. Cummings
Affiliation:
California Department of State Hospitals, Psychopharmacology Resource Network, Department of State Hospitals–Patton, Patton, California 92369, USA
George Proctor
Affiliation:
California Department of State Hospitals, Psychopharmacology Resource Network, Department of State Hospitals–Patton, Patton, California 92369, USA
*
*Address for correspondence: Jonathan M. Meyer, MD, California Department of State Hospitals, Psychopharmacology Resource Network, Department of State Hospitals–Patton, 3102 East Highland Avenue, Patton, CA 92369, USA. (Email: [email protected])
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Abstract

Irreversible monoamine oxidase inhibitor (MAOI) antidepressants have significant efficacy in treatment-resistant unipolar depression, but in some instances patients may not achieve remission. Among the adjunctive and augmentation strategies, certain second-generation antipsychotics (SGAs) have approval for inadequate responders to antidepressant therapy, including aripiprazole, brexpiprazole, and quetiapine, with lurasidone and the olanzapine/fluoxetine combination indicated for bipolar depression. Clinicians may eschew SGA options in part due to the limited literature on SGA–MAOI combinations, with only one published case involving aripiprazole, and none for olanzapine, lurasidone, or brexpiprazole. In addition to the limited publication history on SGA–MAOI treatment, clinicians may also be deterred by uncertainty regarding SGA mechanisms and the risk of serotonin syndrome or other adverse outcomes. This paper describes the case of a 54-year-old male with a history of psychotic unipolar depression treated with a combination of phenelzine, aripiprazole, and quetiapine, and reviews the 12 published cases of SGA–MAOI combination therapy with a focus on the pharmacological basis for serotonin syndrome, and the SGA mechanisms that should not be associated with a risk for this syndrome.

Keywords

Monoamine oxidase inhibitoraripiprazolequetiapinedepressionantipsychotic
Type
Case-Based Review Article
Information
CNS Spectrums , Volume 22 , Issue 5 , October 2017 , pp. 391 - 396
Copyright
© Cambridge University Press 2016 

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