Adding Antipsychotic Meds to Depression Treatment Offers Risks, Little Benefit, Metro State Study Finds

Article excerpt

Medications known as atypical antipsychotics, which are widely prescribed in the United States as an add-on therapy for the treatment of depression, are associated with few benefits and significant side effects, such as weight gain and excessive sleepiness, according to a study published Tuesday in the journal PLOS Medicine.

This finding may help patients and their doctors make more informed decisions about the risk-benefit profile of treatments for depression that combine these two types of medications.

Only one-third of patients with depression respond to antidepressant medications, one of the key reasons the add-on use of antipsychotics has become so popular. Aggressive marketing by the pharmaceutical companies that make these drugs is another. In the United States, the estimated number of annual patient visits to doctors in which an antipsychotic medication was prescribed as an adjunct therapy for depression nearly doubled (from 2 million to 3.9 million visits) from the mid-1990s to the late-2000s.

"It's become pretty clear that antipsychotics are being used at an increased rate for depression over the last few years, so we wanted to see if the evidence supported that practice," said Glen Spielmans, the new study's lead author, in a phone interview earlier this week. Spielmans is a researcher and associate professor of psychology at Metropolitan State University in St. Paul. [Full disclosure: I teach writing and editing courses at Metro State.]

Small benefit, significant risks

For the study, Spielmans and his colleagues examined 14 previously published and unpublished randomized clinical trials in which the combined use of an anti-depressant and an antipsychotic medication were compared to the use of an anti-depressant with a placebo. The medications investigated in the studies were aripiprazole (Abilify), olanzapine/fluoxetine (Symbyax), quetiapine (Seroquel) and risperidone (Risperdal).

A careful analysis of the data from the 14 studies showed a small benefit from the antipsychotic medications on lifting the symptoms of depression. But when the researchers looked at a more meaningful outcome -- whether the patients' quality of life had improved -- no benefit was found.

"In terms of quality of life and how well people were functioning, there was really not much evidence that these drugs did anything," said Spielmans.

The addition of the antipsychotic medications was associated, however, with more adverse side effects, including weight gain, akathisia (a feeling of restlessness often accompanied by an urge to physically move), sleepiness and abnormal results from cholesterol and other metabolic-related laboratory tests.

"Taken together," wrote Spielmans and his study's co-authors, "our meta-analysis found evidence of (1) some improvement in clinician-assessed depressive symptoms, (2) little evidence of substantial benefit in overall well-being, and (3) abundant evidence of potential treatment-related harm. …