Adjunctive Atypical Antipsychotic Treatment for Major Depressive Disorder: A Meta-Analysis of Depression, Quality of Life, and Safety Outcomes

Spielmans, Glen I.; Berman, Micah L.; Linardatos, Eftihia; Rosenlicht, Nicholas; Perry, Angela; Tsai, Alexander C.

doi:10.1371/journal.pmed.1001403

Cited by 225 publications

(142 citation statements)

References 78 publications

Supporting

Mentioning

131

Contrasting

Unclassified

Order By: Relevance

“…Three meta-analyses of the use of atypical antipsychotics for augmentation in TRD have been published [19,93,94]. The first meta-analysis by Papakostas et al [93] showed a pooled response rate of 57% for patients given atypical antipsychotics, compared with 35% for placebo.…”

Section: Resultsmentioning

confidence: 99%

The Integrative Management of Treatment-Resistant Depression: A Comprehensive Review and Perspectives

Carvalho

Berk

Hyphantis

et al. 2014

Psychother Psychosom

View full text Add to dashboard Cite

Background: Major depressive disorder is a prevalent and disabling illness. Notwithstanding numerous advances in the pharmacological treatment of depression, approximately 70% of patients do not remit after first-line antidepressant treatment. Methods: The MEDLINE/PubMed, EMBASE and ClinicalTrials.gov electronic databases were searched from inception to October 1, 2013, for randomized controlled trials (RCT), relevant open-label trials, meta-analyses and ongoing trials of pharmacological and psychotherapeutic approaches to treatment-resistant depression (TRD). Results: Switching to a different antidepressant is a useful option following nonresponse to a first-line agent. Although widely used in clinical practice, there is limited evidence to support antidepressant combination for TRD. Notwithstanding evidence for lithium or T₃ augmentation to be successful in TRD, most studies were carried out when participants were treated with tricyclic antidepressants (TCA). Of the available strategies to augment the response to new-generation antidepressants, the use of some atypical antipsychotics is best supported by evidence. Several novel therapeutic options are currently discussed. Evidence suggests that cognitive therapy (CT) is an effective strategy for TRD. Conclusions: The success of switching to a different antidepressant following a first-line agent is supported by evidence, but there is limited evidence for effective combination strategies. Lithium and T₃ augmentation of TCA have the strongest evidence base for successful treatment of TRD. The use of augmentation of newer-generation antidepressants with atypical antipsychotics is supported by a growing evidence base. Current evidence supports CT as an effective strategy for TRD. There is a need for additional large-scale RCT of TRD. The development of new antidepressants targeting novel pathways opens a promising perspective for the management of TRD.

show abstract

Section: Resultsmentioning

confidence: 99%

The Integrative Management of Treatment-Resistant Depression: A Comprehensive Review and Perspectives

Carvalho

Berk

Hyphantis

et al. 2014

Psychother Psychosom

View full text Add to dashboard Cite

show abstract

“…However, there is no firm empirical basis for placing undue value on this measure as opposed to other outcomes examined in our analysis. Indeed, in adult depression research, it has been argued that measures outside of clinician-rated depression scales add important information in understanding overall well-being [7,9,10,11]. …”

Section: Discussionmentioning

confidence: 99%

“…Because we found very few measures within each aforementioned category (including no positive affect measures), we opted to pool these measures as a proxy for overall well-being. In a recent meta-analysis of atypical antipsychotic augmentation treatment for adult depression, measures of quality of life and functioning were similarly pooled to create a composite for well-being [9]. …”

Section: Methodsmentioning

confidence: 99%

“…Measures of social functioning and health-related quality of life are useful guides in determining the effectiveness of antidepressants; further, calls have been made for the regular inclusion of such measures in clinical trials of antidepressants [7,8,9]. If a treatment improves overall well-being, benefits should be apparent on rating scales measuring domains such as social functioning and quality of life [10].…”

mentioning

confidence: 99%

See 1 more Smart Citation

The Efficacy of Antidepressants on Overall Well-Being and Self-Reported Depression Symptom Severity in Youth: A Meta-Analysis

Spielmans

Gerwig²

2014

Psychother Psychosom

Self Cite

View full text Add to dashboard Cite

Background: Recent meta-analyses of the efficacy of second-generation antidepressants for youth have concluded that such drugs possess a statistically significant advantage over placebo in terms of clinician-rated depressive symptoms. However, no meta-analysis has included measures of quality of life, global mental health, self-esteem, or autonomy. Further, prior meta-analyses have not included self-reports of depressive symptoms. Methods: Studies were selected through searching Medline, PsycINFO, and the Cochrane Central Register for Controlled Trials databases as well as GlaxoSmithKline's online trial registry. We included self-reports of depressive symptoms and pooled measures of quality of life, global mental health, self-esteem, and autonomous functioning as a proxy for overall well-being. Results: We found a nonsignificant difference between second-generation antidepressants and placebo in terms of self-reported depressive symptoms (k = 6 trials, g = 0.06, p = 0.36). Further, pooled across measures of quality of life, global mental health, self-esteem, and autonomy, antidepressants yielded no significant advantage over placebo (k = 3 trials, g = 0.11, p = 0.13). Discussion: Though limited by a small number of trials, our analyses suggest that antidepressants offer little to no benefit in improving overall well-being among depressed children and adolescents.

show abstract

“…Meta-analyses have demonstrated greater efficacy of these medications versus placebo as augmentation in patients with treatment-resistant MDD. Nelson and Papakostas 50 found ORs of 1.69 and 2.00 for response and remission, respectively; Spielmans et al 51 also showed statistically significant effects on response and remission rates as well as clinician-rated depression severity measures.…”

Section: Augmentation Strategiesmentioning

confidence: 95%

Utilizing the <em>DSM-5</em> Anxious Distress Specifier to Develop Treatment Strategies for Patients With Major Depressive Disorder

Thase¹,

Weisler²,

Manning

et al. 2017

J. Clin. Psychiatry

View full text Add to dashboard Cite

Adjunctive Atypical Antipsychotic Treatment for Major Depressive Disorder: A Meta-Analysis of Depression, Quality of Life, and Safety Outcomes

Cited by 225 publications

References 78 publications

The Integrative Management of Treatment-Resistant Depression: A Comprehensive Review and Perspectives

The Integrative Management of Treatment-Resistant Depression: A Comprehensive Review and Perspectives

The Efficacy of Antidepressants on Overall Well-Being and Self-Reported Depression Symptom Severity in Youth: A Meta-Analysis

Utilizing the <em>DSM-5</em> Anxious Distress Specifier to Develop Treatment Strategies for Patients With Major Depressive Disorder

Contact Info

Product

Resources

About