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:10.1176/appi.focus.140202

Cited by 66 publications

(89 citation statements)

References 60 publications

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“…[1][2][3][4][5][6] This increase has been driven primarily by prescriber preference for atypical (or second-generation) antipsychotics, 1,2 higher costs of newer agents compared with typical (or first-generation) antipsychotics 1 and a widening range of on-and off-label uses. [3][4][5][7][8][9] The increase in the use of atypical antipsychotic medications has been particularly marked in older adults with dementia. 8,[10][11][12] Since the early 2000s, there has been a growing appreciation for antipsychotic-related adverse effects among older people with dementia, which prompted warnings from the manufacturers and Health Canada regarding the safety of risperidone and olanzapine in 2002 and 2004, respectively.…”

mentioning

confidence: 99%

Trends in the use and cost of antipsychotics among older adults from 2007 to 2013: a repeated cross-sectional study

et al. 2016

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Background:Recently, several new atypical antipsychotic agents have been introduced in Ontario, and regulatory warnings have been issued regarding use of atypical antipsychotics in older adults. We sought to establish the impact of newer atypical antipsychotics on prescribing rates and costs. Methods:We performed a population-based cross-sectional study of Ontario adults aged 65 years or more using atypical antipsychotics from Jan. 1, 20071, , to Mar. 31, 2013. These people have universal access to publicly funded drugs through the Ontario Health Insurance Plan and the Ontario Drug Benefit. We conducted time-series analysis to assess the impact of the introduction of new atypical antipsychotics on rates of use of atypical antipsychotics and associated expenditures. Results:Rates of atypical antipsychotic use increased following the introduction of new agents in 2009, from 27.6 users per 1000 older adults in the third quarter of 2009 to 29.1 users per 1000 older adults at the end of the study period (p = 0.04). Although prescribing rates for the newer atypical agents (paliperidone, ziprasidone and aripiprazole) remained low relative to their older counterparts (risperidone, olanzapine and quetiapine), rates of aripiprazole use rose to 1.0 user per 1000 older adults by the end of the study period. The proportion of prescriptions that were for brand-name agents fell from 57.5% in the second quarter of 2007 to 6.1% in the second quarter of 2009, and then rose to 11.7% by the end of the study period. By the first quarter of 2013, newer atypical antipsychotic agents were used by 4.4% of atypical antipsychotic users but accounted for 14.1% ($1.2 million of $8.5 million) of atypical antipsychotic expenditures. Interpretation:Although the overall prevalence of use of new atypical antipsychotic agents remains low, their introduction has led to increased prescribing of this class of drugs in older adults. Given the potential cost implications, further study of these trends would be prudent. Abstract ResearchResearch CMAJ OPEN CMAJ OPEN 4(2) E293

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confidence: 99%

Trends in the use and cost of antipsychotics among older adults from 2007 to 2013: a repeated cross-sectional study

et al. 2016

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“…Overall, sPielmans, et al 2013, found that treatment was linked to several adverse events, including akathisia (aripiprazole), sedation (quetiapine, olanzapine/fluoxetine combination (OFC), and aripiprazole), abnormal metabolic laboratory results (quetiapine and OFC), and weight gain (all four drugs, especially OFC). (sPielmans et al, 2013) So, it is relevant to attempt to thoroughly understand the risk-benefit profiles of these adjunctive treatments for major depressive disorder taking into account the lack of benefit with regards to quality of life or functional impairment, and the abundant evidence of potential treatment-related harm (sPielmans et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Treating patients with antipsychotics: an individualized management

Maia¹,

Meireles²,

Miná³

et al. 2015

Int Arch Med

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Introduction: Subjective well-being, quality of life, cognition and psychosocial performance, including employment, have become endpoints of interest and goals for patients, families, clinicians and researchers. In this line, it is important to clarify the adverse effects caused by antipsychotics in order to innovate and complement treatment of patients with an individualize approach according to the patient's needs and predispositions. Objectives:Discuss new treatment's way for patients using antipsychotics, elucidating the pros and cons of their use.Results: Atypical antipsychotics cause weight gain and lead to a higher risk of diabetes and other metabolic sequelae than their typical counterparts. Besides, second-generation(atypical) has also shown adverse effects like: akathisia, sedation, abnormal metabolic laboratory results, and weight gain. On the other hand, talking about the first-gentration (typical) antipsychotics, their clinical effectiveness is challenged by increased acute and chronic extrapyramidal side effects and related symptoms of dysphoria, compared to second-generation (atypical) antipsychotics. In addition, available evidence indicates that antipsychotic medications increase the risk of cerebrovascular adverse events (CVAEs) and death when used to treat elderly patients with Behavioral and Psychological Symptoms of Dementia (BPSD). Besides, some studies show that patient populations that are prescribed antipsychotic agents have a higher cardiovascular mortality rate than the general population. Considering that, we can see that each psychotic patient will need an individualized treatment according to their physical, social and psychological limitations and needs, leading us to realize the significance of this paper since it emphasizes the holistic management of this kind of patient.

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“…In short, akathisia and Adverse Effects of Second-Generation Antipsychotics restlessness are the most common problematic adverse effects associated with adjunctive therapy with aripiprazole and brexpiprazole; sedation is the most common problematic adverse effect associated with adjunctive quetiapine therapy, and increased appetite and weight gain are the most problematic adverse effects associated with adjunctive therapy with olanzapine. [17][18][19] If NNH values are computed on the incidence of adverse effects, rather than attrition due to intolerable adverse effects, a much harsher view of tolerability is revealed. 13,16 For example, because about onehalf of patients treated with quetiapine will report some degree of sedation or daytime sleepiness during the first week of therapy (compared with <10% on placebo), an NNH value of 3 can be estimated.…”

Section: Akathisiamentioning

confidence: 99%

“…17,18 Clinicians can take some comfort in the fact that weight can be measured so accurately and inexpensively. Spielmans and colleagues 17 included weight change in their systematic review and meta-analysis.…”

Section: Weight Gainmentioning

confidence: 99%

Adverse Effects of Second-Generation Antipsychotics as Adjuncts to Antidepressants

Thase

2016

Psychiatric Clinics of North America

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

Cited by 66 publications

References 60 publications

Trends in the use and cost of antipsychotics among older adults from 2007 to 2013: a repeated cross-sectional study

Trends in the use and cost of antipsychotics among older adults from 2007 to 2013: a repeated cross-sectional study

Treating patients with antipsychotics: an individualized management

Adverse Effects of Second-Generation Antipsychotics as Adjuncts to Antidepressants

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