Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-22T08:06:06.543Z Has data issue: false hasContentIssue false
  • English
  • Français

Examining the Evidence on Augmentation with Atypical Antipsychotics

Published online by Cambridge University Press:  07 November 2014

Get access Rights & Permissions [Opens in a new window]

Extract

There is mounting evidence to suggest that the efficacy of all available antidepressants when used as monotherapy to treat major depressive disorder (MDD) is, at best, modest. For example, a meta-analysis of all double-blind placebo-controlled studies of antidepressants published since 1980 revealed response rates of 53% for antidepressants versus 36% for placebo (difference in response rate of 16.8%) (Slide 1). To make matters worse, if one is to assume that “negative trials” (ie, trials which do not demonstrate the superiority of a drug over placebo) are less likely to be published than “positive trials” (trials which demonstrate the superiority of a drug versus placebo), it is quite possible that the margin of efficacy of antidepressants when compared to placebo is ≤16.8%. Thus, if one were to include all unpublished along with published double-blind, placebo-controlled trials of antidepressants for MDD, this efficacy margin could be ≤10%.

Type
Expert Roundtable Supplement
Information
CNS Spectrums , Volume 12 , Issue S22: Augmentation Strategies in the Treatment of Major Depressive Disorder , December 2007 , pp. 10 - 12
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Papakostas, GI, Fava, M. Does the probability of receiving placebo influence the likelihood of responding to placebo or clinical trial outcome? A meta-regression of double-blind, randomized clinical trials in MDD. Neuropsychopharmacology. 2006;31(suppl 1):s158.Google Scholar
2.Petersen, T, Papakostas, GI, Posternak, MA, et al.Empirical testing of two models for staging antidepressant treatment resistance. J Clin Psychopharmacol. 2005;25(4):336–341.CrossRefGoogle ScholarPubMed
3.Trivedi, MH, Rush, AJ, Wisniewski, SR, et al; STAR*D Study Team. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry. 2006:163(1):28–40.Google Scholar
4.Papakostas, GI. Augmentation of standard antidepressants with atypical antipsychotic agents for treatment-resistant major depressive disorder. Essent Psychopharmacol. 2005;6(4):209–220.Google Scholar
5.Ostroff, RB, Nelson, JC. Risperidone augmentation of selective serotonin reuptake inhibitors in major depression. J Clin Psychiatry. 1999;60(4):256–259.Google Scholar
6.Shelton, RC, Tollefson, GD, Tohen, M, et al.A novel augmentation strategy for treating resistant major depression. Am J Psychiatry. 2001;158(1):131–134.Google Scholar
7.Shelton, RC, Williamson, DJ, Corya, SA, et al.Olanzapine/fluoxetine combination for treatment-resistant depression: a controlled study of SSRI and nortriptyline resistance. J Clin Psychiatry. 2005;66(10):1289–1297.Google Scholar
8.Corya, SA, Williamson, D, Sanger, TM, Briggs, SD, Case, M, Tollefson, G. A randomized, double-blind comparison of olanzapine/fluoxetine combination, olanzapine, fluoxetine, and venlafaxine in treatment-resistant depression. Depress Anxiety. 2006;23(6):364–372.Google Scholar
9.Keitner, GI. Garlow, SJ, Ryan, CE, et al.Risperidone augmentation for patients with difficult-to-treat major depression. Poster presented at: 159th Annual Meeting of the American Psychiatric Association; May 20-26,2006; Toronto, Canada.Google Scholar
10.Gharabawi, G, Canuso, C, Pandina, G, et al.A double-blind, placebo-controlled trial of adjunctive risperidone for treatment-resistant major depressive disorder. Poster presented at: 25th Collegium Internationale Neuropsychopharmacologicum; July 9-13, 2006; Chicago, Illinois.Google Scholar
11.Khullar, A. Chokka, P, Fullerton, D, McKenna, S, Blackman, A. Quetiapine as treatment of non-psychotic unipolar depression with residual symptoms: double blind, randomized, placebo controlled study. Poster presented at: 159th Annual Meeting of the American Psychiatric Association; May 20-26,2006; Toronto, Canada.Google Scholar
12.Mattingly, G, Ilivicky, H, Canale, J, Anderson, R. Quetiapine augmentation for treatmentresistant depression. Poster presented at: 159th Annual Meeting of the American Psychiatric Association; May 20-26, 2006; Toronto, Canada.Google Scholar
13.McIntyre, AW, Gendron, A, Mcintyre, A. Quetiapine augmentation of SSRIs/SNRIs in major depression with anxiety. Poster presented at: 159th Annual Meeting of the American Psychiatric Association; May 20-26, 2006; Toronto, Canada.Google Scholar
14.Thase, ME, Corya, SA, Osuntokun, O, et al.A randomized, double-blind comparison of olanzapine/fluoxetine combination, olanzapine, and fluoxetine in treatment-resistant major depressive disorder. J Clin Psychiatry. 2007;68(2):224–236.Google Scholar
15.Papakostas, GI, Shelton, RC, Smith, J, Fava, M. Augmentation of antidepressants with atypical antipsychotic medications for treatment-resistant major depressive disorder: a meta-analysis. J Clin Psychiatry. 2007;68(6):826–831.Google Scholar
16.Papakostas, GI, Petersen, TJ, Nierenberg, AA, et al.Ziprasidone augmentation of selective serotonin reuptake inhibitors (SSRIs) for SSRI-resistant major depressive disorder. J Clin Psychiatry. 2004;65(2):217–221.Google Scholar
17.Berman, RM, Marcus, RN, Swanink, R, et al.The efficacy and safety of aripiprazole as adjunctive therapy in major depressive disorder: a multicenter, randomized, doubleblind, placebo-controlled study. J Clin Psychiatry. 2007;68(6):843–583.CrossRefGoogle ScholarPubMed
18.Thase, ME, Marcus, RN, Hennicken, D, et al. Efficacy and safety of aripiprazole as adjunctive therapy in major depressive disorder: a multicenter, randomized, double-blind, placebo-controlled study (Study CN 138-163). Poster presented at: 61st Annual Convention of the Society of Biological Psychiatry; May 18-20, 2006; San Diego, California.Google Scholar
19.Rapaport, MH, Gharabawi, GM, Canuso, CM, et al.Effects of risperidone augmentation in patients with treatment-resistant depression: Results of open-label treatment followed by double-blind continuation. Neuropsychopharmacology. 2006;31(11):2505–2513.Google Scholar