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Examining the Evidence on Augmentation with Atypical Antipsychotics

Published online by Cambridge University Press:  07 November 2014

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Extract

There is mounting evidence to suggest that the efficacy of all available antidepressants when used as monotherapy to treat major depressive disorder (MDD) is, at best, modest. For example, a meta-analysis of all double-blind placebo-controlled studies of antidepressants published since 1980 revealed response rates of 53% for antidepressants versus 36% for placebo (difference in response rate of 16.8%) (Slide 1). To make matters worse, if one is to assume that “negative trials” (ie, trials which do not demonstrate the superiority of a drug over placebo) are less likely to be published than “positive trials” (trials which demonstrate the superiority of a drug versus placebo), it is quite possible that the margin of efficacy of antidepressants when compared to placebo is ≤16.8%. Thus, if one were to include all unpublished along with published double-blind, placebo-controlled trials of antidepressants for MDD, this efficacy margin could be ≤10%.

Type
Expert Roundtable Supplement
Information
CNS Spectrums , Volume 12 , Issue S22: Augmentation Strategies in the Treatment of Major Depressive Disorder , December 2007 , pp. 10 - 12
Copyright
Copyright © Cambridge University Press 2007

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References

1.Papakostas, GI, Fava, M. Does the probability of receiving placebo influence the likelihood of responding to placebo or clinical trial outcome? A meta-regression of double-blind, randomized clinical trials in MDD. Neuropsychopharmacology. 2006;31(suppl 1):s158.Google Scholar
2.Petersen, T, Papakostas, GI, Posternak, MA, et al.Empirical testing of two models for staging antidepressant treatment resistance. J Clin Psychopharmacol. 2005;25(4):336–341.CrossRefGoogle ScholarPubMed
3.Trivedi, MH, Rush, AJ, Wisniewski, SR, et al; STAR*D Study Team. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry. 2006:163(1):28–40.Google Scholar
4.Papakostas, GI. Augmentation of standard antidepressants with atypical antipsychotic agents for treatment-resistant major depressive disorder. Essent Psychopharmacol. 2005;6(4):209–220.Google Scholar
5.Ostroff, RB, Nelson, JC. Risperidone augmentation of selective serotonin reuptake inhibitors in major depression. J Clin Psychiatry. 1999;60(4):256–259.Google Scholar
6.Shelton, RC, Tollefson, GD, Tohen, M, et al.A novel augmentation strategy for treating resistant major depression. Am J Psychiatry. 2001;158(1):131–134.Google Scholar
7.Shelton, RC, Williamson, DJ, Corya, SA, et al.Olanzapine/fluoxetine combination for treatment-resistant depression: a controlled study of SSRI and nortriptyline resistance. J Clin Psychiatry. 2005;66(10):1289–1297.Google Scholar
8.Corya, SA, Williamson, D, Sanger, TM, Briggs, SD, Case, M, Tollefson, G. A randomized, double-blind comparison of olanzapine/fluoxetine combination, olanzapine, fluoxetine, and venlafaxine in treatment-resistant depression. Depress Anxiety. 2006;23(6):364–372.Google Scholar
9.Keitner, GI. Garlow, SJ, Ryan, CE, et al.Risperidone augmentation for patients with difficult-to-treat major depression. Poster presented at: 159th Annual Meeting of the American Psychiatric Association; May 20-26,2006; Toronto, Canada.Google Scholar
10.Gharabawi, G, Canuso, C, Pandina, G, et al.A double-blind, placebo-controlled trial of adjunctive risperidone for treatment-resistant major depressive disorder. Poster presented at: 25th Collegium Internationale Neuropsychopharmacologicum; July 9-13, 2006; Chicago, Illinois.Google Scholar
11.Khullar, A. Chokka, P, Fullerton, D, McKenna, S, Blackman, A. Quetiapine as treatment of non-psychotic unipolar depression with residual symptoms: double blind, randomized, placebo controlled study. Poster presented at: 159th Annual Meeting of the American Psychiatric Association; May 20-26,2006; Toronto, Canada.Google Scholar
12.Mattingly, G, Ilivicky, H, Canale, J, Anderson, R. Quetiapine augmentation for treatmentresistant depression. Poster presented at: 159th Annual Meeting of the American Psychiatric Association; May 20-26, 2006; Toronto, Canada.Google Scholar
13.McIntyre, AW, Gendron, A, Mcintyre, A. Quetiapine augmentation of SSRIs/SNRIs in major depression with anxiety. Poster presented at: 159th Annual Meeting of the American Psychiatric Association; May 20-26, 2006; Toronto, Canada.Google Scholar
14.Thase, ME, Corya, SA, Osuntokun, O, et al.A randomized, double-blind comparison of olanzapine/fluoxetine combination, olanzapine, and fluoxetine in treatment-resistant major depressive disorder. J Clin Psychiatry. 2007;68(2):224–236.Google Scholar
15.Papakostas, GI, Shelton, RC, Smith, J, Fava, M. Augmentation of antidepressants with atypical antipsychotic medications for treatment-resistant major depressive disorder: a meta-analysis. J Clin Psychiatry. 2007;68(6):826–831.Google Scholar
16.Papakostas, GI, Petersen, TJ, Nierenberg, AA, et al.Ziprasidone augmentation of selective serotonin reuptake inhibitors (SSRIs) for SSRI-resistant major depressive disorder. J Clin Psychiatry. 2004;65(2):217–221.Google Scholar
17.Berman, RM, Marcus, RN, Swanink, R, et al.The efficacy and safety of aripiprazole as adjunctive therapy in major depressive disorder: a multicenter, randomized, doubleblind, placebo-controlled study. J Clin Psychiatry. 2007;68(6):843–583.CrossRefGoogle ScholarPubMed
18.Thase, ME, Marcus, RN, Hennicken, D, et al. Efficacy and safety of aripiprazole as adjunctive therapy in major depressive disorder: a multicenter, randomized, double-blind, placebo-controlled study (Study CN 138-163). Poster presented at: 61st Annual Convention of the Society of Biological Psychiatry; May 18-20, 2006; San Diego, California.Google Scholar
19.Rapaport, MH, Gharabawi, GM, Canuso, CM, et al.Effects of risperidone augmentation in patients with treatment-resistant depression: Results of open-label treatment followed by double-blind continuation. Neuropsychopharmacology. 2006;31(11):2505–2513.Google Scholar