A systematic review and meta‐analysis of maintenance treatment for psychotic depression

Al-Wandi, Ahmed; Holmberg, C.; Landén, Mikael; Nordenskjöld, Axel

doi:10.1080/08039488.2021.1990997

Cited by 5 publications

(19 citation statements)

References 40 publications

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“…Although the proportions of the collected antidepressants were similar between the treatment groups, various antipsychotics were collected by the combination therapy group. To our knowledge, there are only four antipsychotics that have been examined as part of antidepressant + antipsychotic combination therapy in randomized controlled studies, namely, olanzapine, quetiapine, perphenazine, and haloperidol 8–10,35–37 . In our study 50.7% of the patients collected olanzapine, 11.2% quetiapine, 6.6% haloperidol, and 1.5% perphenazine.…”

Section: Discussionmentioning

confidence: 71%

“…After 36 weeks of follow‐up, there was a statistically significant difference in favor of combination therapy; 23.2% of the participants finishing the study suffered a relapse in the combination group compared with 58.6% in the monotherapy group. But, when all three studies in our review were synthesized in meta‐analysis, there was no significant difference between combination therapy and monotherapy; however, the evidence was of low quality due to substantial heterogeneity between the studies, small sample sizes, and few events 10 …”

Section: Introductionmentioning

confidence: 89%

“…The existing data on maintenance treatment are even more scarce. Our group recently conducted a systematic review of maintenance treatment for preventing relapse in psychotic depression 10 . We identified three studies comparing antidepressant + antipsychotic combination therapy with antidepressant monotherapy.…”

Section: Introductionmentioning

confidence: 99%

“…Our group recently conducted a systematic review of maintenance treatment for preventing relapse in psychotic depression. 10 We identified three studies comparing antidepressant + antipsychotic combination therapy with antidepressant monotherapy. In the largest of these studies, conducted by Flint et al, 126 patients were randomized under double-blind conditions to receive sertraline and olanzapine combination therapy or sertraline and placebo in the maintenance phase.…”

mentioning

confidence: 99%

“…But, when all three studies in our review were synthesized in metaanalysis, there was no significant difference between combination therapy and monotherapy; however, the evidence was of low quality due to substantial heterogeneity between the studies, small sample sizes, and few events. 10 If antipsychotics are to be used in the maintenance phase it is important to determine for how long the treatment should continue, since antipsychotics are associated with many potential side effects including metabolic, extrapyramidal, and anticholinergic side effects. 12 In a study by Rothschild et al, they concluded that most patients do not need antipsychotic treatment for more than 4 months.…”

mentioning

confidence: 99%

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Antipsychotics in the maintenance phase for psychotic depression

Al‐Wandi,

Landén,

Nordenskjöld

2023

Acta Psychiatr Scand

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ObjectiveThis study aimed to associate antidepressants with versus without antipsychotics with readmission and suicide in patients with psychotic unipolar depression.MethodsSwedish national registers were used to identify inpatients with psychotic unipolar depression, treated 2007–2016. The participants collected antidepressants with or without antipsychotics from a pharmacy within 14 days after discharge and were followed up for 2 years. The primary outcome was hospital readmission due to any psychiatric disorder, suicide attempt, or completed suicide. Cox regression was used to analyze the data, which were adjusted for sex, age, prior admissions, comorbidity, electroconvulsive therapy, and other pharmacological treatments.ResultsWe identified 4391 patients, of which 2972 were in the antidepressant + antipsychotic combination therapy group, and 1419 were in the antidepressant monotherapy group. After 2 years, 42.3% and 36.6% of patients were readmitted or committed suicide in the combination therapy and monotherapy group, respectively. Monotherapy was significantly associated with a lower risk of reaching the outcome in the main analysis (hazard ratio = 0.86; 95% confidence interval: 0.77–0.95). The results went in the same direction in all sensitivity analyses.ConclusionOur findings do not indicate any advantage of adding antipsychotics as adjunctive to antidepressants as maintenance treatment. Considering the wide use, known side effects, and the current lack of evidence supporting the benefit, further studies on the effect of antipsychotics in the maintenance phase of psychotic unipolar depression are urgently warranted.

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Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Antipsychotics in the maintenance phase for psychotic depression

Al‐Wandi,

Landén,

Nordenskjöld

2023

Acta Psychiatr Scand

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Challenges in the Treatment of Psychotic Bipolar Depression

Cintrón Pastrana,

Irizarry Flores,

Rothschild

2024

J Clin Psychopharmacol

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Background Psychotic bipolar depression (PBD) is a prevalent yet understudied psychiatric illness, and there are no specific guidelines or Food and Drug Administration–approved medications for its treatment. Recent studies suggest that some antipsychotics and mood stabilizers may be effective in managing bipolar depression; however, their effectiveness for PBD remains unclear. Given the urgent need for more focused research for managing PBD, we conducted a literature review to summarize the existing literature on PBD. Methods We conducted an electronic literature search from the 1960s to 2023, utilizing PubMed, MEDLINE, EMBASE, and Google, and selected studies based on their relevance to PBD. Findings PBD is a complex disorder, with 50%–75% of patients with bipolar disorder exhibiting psychotic features. This likelihood increases among those with a history of psychotic mania. Treatment guidelines often recommend a combination of mood stabilizers, antipsychotics, or electroconvulsive therapy, but they do not specify a first-line treatment. PBD symptoms can be masked by mixed high mood and energy feelings, potentially delaying diagnosis and treatment while increasing suicide risk. Limited research has evaluated outcomes of various treatments for PBD, and despite the lack of evidence for superior efficacy, in clinical practice, antipsychotics are frequently prescribed. Notably, combining an antipsychotic with selective noradrenaline reuptake inhibitors or tricyclic antidepressants may be effective, but including a mood stabilizer is necessary. Conclusion PBD poses a significant challenge in mental health due to its severity and the lack of consensus on optimal treatment approaches. There is a critical need for more dedicated clinical trials and research to answer key questions about the effective treatment of acute PBD, ideal follow-up care, traits of responders to different therapies, and decision models for subsequent treatments.

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Maintenance treatment of psychotic depression: Is antipsychotic medication needed?

Rothschild

2023

Acta Psychiatr Scand

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A systematic review and meta‐analysis of maintenance treatment for psychotic depression

Cited by 5 publications

References 40 publications

Antipsychotics in the maintenance phase for psychotic depression

Antipsychotics in the maintenance phase for psychotic depression

Challenges in the Treatment of Psychotic Bipolar Depression

Maintenance treatment of psychotic depression: Is antipsychotic medication needed?

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