Atypical Antipsychotic Augmentation Strategies in the Context of Guideline-based Care for the Treatment of Major Depressive Disorder

Patkar, Ashwin A.; Pae, Chi‐Un

doi:10.1007/s40263-012-0031-0

Cited by 45 publications

(28 citation statements)

References 30 publications

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“…There is no explanation for this association, except for assuming that ECT is usually used for schizophrenia with depressive symptoms, while certain SGA, such as quetiapine, olanzapine and aripiprazole, are also thought to be effective for these symptoms. 22,23 There are several limitations to this study. First, a number of variables, such as history of psychotropic drug treatment and response to antipsychotics, were not recorded.…”

Section: Discussionmentioning

confidence: 97%

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Use of electroconvulsive therapy for Asian patients with schizophrenia (2001–2009): Trends and correlates

Xiang

Ungvári

Correll

et al. 2015

Psychiatry Clin Neurosci

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Aims Little is known about electroconvulsive therapy (ECT) use in Asian inpatients with schizophrenia. This study examined trends of ECT use for schizophrenia patients in Asia between 2001 and 2009 and its independent demographic and clinical correlates. Methods Data on 6761 hospitalized schizophrenia patients (2001 = 2399, 2004 = 2136, and 2009 = 2226) in nine Asian countries and territories were collected by either chart review or interviews during a 1‐month period. Patients’ sociodemographic and clinical characteristics, prescriptions of psychotropic drugs and ECT use were recorded using a standardized protocol and data‐collection procedure. Results The frequency of ECT was 3.3% in the whole sample; rising from 1.8% in 2001 to 3.3% in 2004 and 4.9% in 2009 (P < 0.0001). However, this increased trend was driven solely by increased ECT use in China (P < 0.0001), and the inclusion of India in the 2009 survey. There were wide inter‐country variations: 2001, 0% (Hong Kong, Korea) to 5.9% (China); 2004, 0% (Singapore) to 11.1% (China); 2009, 0% (Hong Kong) to 13.8% (India) and 15.2% (China). Multiple logistic regression analysis of the whole sample revealed that patients receiving ECT were less likely in the 35–64‐year age group, had shorter length of current hospitalization and fewer negative symptoms, and were more likely to receive second‐generation antipsychotic medications compared to those who were not treated with ECT (R2 = 0.264, P < 0.001). Conclusions ECT use for schizophrenia has increased over the past decade in China, being low/relatively stable in other Asian countries/regions. Reasons for substantial variations in ECT frequency in Asia require further study.

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Section: Discussionmentioning

confidence: 97%

“…In this study, patients receiving ECT were more likely to be prescribed SGA. There is no explanation for this association, except for assuming that ECT is usually used for schizophrenia with depressive symptoms, while certain SGA, such as quetiapine, olanzapine and aripiprazole, are also thought to be effective for these symptoms …”

Section: Discussionmentioning

confidence: 99%

Use of electroconvulsive therapy for Asian patients with schizophrenia (2001–2009): Trends and correlates

Xiang

Ungvári

Correll

et al. 2015

Psychiatry Clin Neurosci

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“…Nonetheless, four antipsychotic medications have received approval by the United States Food and Drug Administration (FDA) for use as an adjunct in inadequately treated major depressive disorder (MDD) or bipolar depression (these include quetiapine, olanzapine, aripiprazole, and lurasidone). It is important to note that the standard of care and treatment guidelines does not suggest that SGAs be used as first‐line agents for the treatment of depression (Patkar and Pae, ). This paper reviews the receptor profiles of SGAs that are useful in the treatment of depressive illness and presents three characteristics that are useful in utilizing these agents (Table ).…”

Section: Amine Receptors and The Behavioral Effects They Appear To Mementioning

confidence: 99%

Antipsychotics as antidepressants

Roberts

Lohano

El‐Mallakh

2015

Asia-Pacific Psychiatry

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Three second-generation antipsychotic (SGA) agents have received FDA approval for adjunctive treatment, to antidepressant, of major depressive disorder: quetiapine, aripiprazole, and olanzapine. Additionally, quetiapine and lurasidone have been approved for the treatment of bipolar depression. There are data suggesting that quetiapine is effective for major depressive disorder as monotherapy. These agents are effective for depression only at subantipsychotic doses. Receptor profiles predict that all SGA will have anxiolytic effects as subantipsychotic doses but that all will be dysphorogenic at full antipsychotic doses (i.e., produce a depression-like clinical picture). The antidepressant effect appears to be unique to some agents, with direct evidence of insignificant antidepressant action for ziprasidone. Three general principles can guide the use of antipsychotics as antidepressants: (i) All SGAs may have anxiolytic effects; (ii) full antipsychotic doses are dysphorogenic, and therefore, subantipsychotic doses are to be used; and (iii) SGAs do not have a general antidepressant effect, rather, this appears to be unique to quetiapine and aripiprazole, and possibly lurasidone.

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“…Treatment options for patients with inadequate response to ADT include increasing the dose, switching to another ADT, adding a second ADT, or initiating adjunctive therapy with another medication such as an atypical antipsychotic [5,6]. A review of the evidence for antidepressant augmentation, combination, and switching strategies concluded that current data unequivocally support the use of certain atypical antipsychotics as a first-line option for augmentation in patients who failed first-line ADT [5].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of brexpiprazole as adjunctive treatment in major depressive disorder: overview of four short-term studies

Thase

Zhang

Weiss

et al. 2019

Expert Opinion on Pharmacotherapy

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Background: There is a need for effective, safe and well-tolerated pharmacotherapies for patients with major depressive disorder (MDD) who have inadequate response to antidepressant treatments (ADTs). This analysis aimed to summarize the short-term efficacy and safety of adjunctive brexpiprazole in adults with MDD. Research design and methods: A pooled analysis of data from the 6-week, randomized, double-blind treatment phases of four studies of adjunctive brexpiprazole 1-3 mg/day versus placebo in outpatients with MDD and inadequate response to ADTs (n = 1,853). Efficacy was measured by Montgomery-Åsberg Depression Rating Scale (MADRS) scores, and safety by treatment-emergent adverse events (TEAEs). Results: ADT + brexpiprazole 2-3 mg/day showed greater improvement in MADRS Total score from baseline to Week 6 than ADT + placebo (least squares mean difference: −2.15; confidence limits: −2.82, −1.48; p < 0.0001; Cohen's d effect size: 0.33). TEAEs with incidence ≥5% with ADT + brexpiprazole 1-3 mg/day were akathisia (8.0% versus 2.6% with ADT + placebo), headache (5.8% versus 6.0%), and weight increased (5.8% versus 1.6%). Conclusions: Adjunctive brexpiprazole is an efficacious and well-tolerated treatment option for adult patients with MDD and inadequate response to ADTs. Study limitations included a lack of active comparator.

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Atypical Antipsychotic Augmentation Strategies in the Context of Guideline-based Care for the Treatment of Major Depressive Disorder

Cited by 45 publications

References 30 publications

Use of electroconvulsive therapy for Asian patients with schizophrenia (2001–2009): Trends and correlates

Use of electroconvulsive therapy for Asian patients with schizophrenia (2001–2009): Trends and correlates

Antipsychotics as antidepressants

Efficacy and safety of brexpiprazole as adjunctive treatment in major depressive disorder: overview of four short-term studies

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