Titre du document / Document title

Augmentation of antidepressants with atypical antipsychotic medications for treatment-resistant major depressive disorder : A meta-analysis

Auteur(s) / Author(s)

PAPAKOSTAS George I. ⁽¹⁾ ; SHELTON Richard C. ⁽²⁾ ; SMITH Juliana ⁽¹⁾ ; FAVA Maurizio ⁽¹⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, ETATS-UNIS
⁽²⁾ Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, Tenn, ETATS-UNIS

Résumé / Abstract

Objective: To examine the efficacy and overall tolerability of augmentation of standard antidepressants with atypical antipsychotic agents for treatment-resistant major depressive disorder. Data Sources: MEDLINE/PubMed, EMBASE, the Cochrane database, and program syllabi from major psychiatric meetings held since 2000 as well as a number of online clinical trial results registries were searched. Makers of atypical antipsychotic agents who do not maintain an online clinical study results registry were contacted directly. Study Selection: Double-blind, randomized, placebo-controlled clinical trials assessing adjunctive treatment of standard antidepressants with an atypical antipsychotic agent for treatment-resistant major depressive disorder were identified. Data Extraction: Data were extracted with the use of a pre-coded form. Data Synthesis: Data from 10 clinical trial reports involving a total of 1500 outpatients with treatment-resistant major depressive disorder were identified and combined using a random-effects model. Patients randomized to adjunctive treatment with an atypical antipsychotic agent were more likely to experience remission (risk ratio [RR] = 1.75, p <.0001) or clinical response (RR = 1.35, p =.001) than patients who received adjunctive placebo. Pooled remission and response rates for the 2 treatment groups were 47.4% vs. 22.3% and 57.2% vs. 35.4%, respectively. Although there was no difference in overall discontinuation rates (p =.929) or the rate of discontinuation due to inefficacy (p =.133) between the 2 treatment groups, the rate of discontinuation due to adverse events was lower among placebo-treated patients (RR = 3.38, p <.0001). Conclusions: These results support the utility of augmenting standard antidepressants with atypical antipsychotic agents for treatment-resistant major depressive disorder. An obvious limitation of this work is the absence of data focusing on the use of aripiprazole and ziprasidone. Future short- as well as long-term studies comparing the efficacy, safety, and tolerability of this versus other adjunctive strategies are warranted.

Revue / Journal Title

The Journal of clinical psychiatry   ISSN 0160-6689 

Source / Source

2007, vol. 68, n^o6, pp. 826-831 [6 page(s) (article)] (45 ref.)

Langue / Language

Anglais

Editeur / Publisher

Physicians Postgraduate Press, Memphis, TN, ETATS-UNIS  (1978) (Revue)

Mots-clés anglais / English Keywords

Mood disorder ; Review ; Metaanalysis ; Depression ; Treatment resistance ; Atypical antipsychotic ; Psychotropic ; Treatment ; Chemotherapy ; Antidepressant agent ;

Mots-clés français / French Keywords

Trouble humeur ; Article synthèse ; Métaanalyse ; Etat dépressif ; Résistance traitement ; Antipsychotique atypique ; Psychotrope ; Traitement ; Chimiothérapie ; Antidépresseur ;

Mots-clés espagnols / Spanish Keywords

Trastorno humor ; Artículo síntesis ; Meta-análisis ; Estado depresivo ; Resistencia tratamiento ; Antipsicótico atípico ; Psicotropo ; Tratamiento ; Quimioterapia ; Antidepresor ;

Localisation / Location

INIST-CNRS, Cote INIST : 9069, 35400014985148.0020