Calling in the Cavalry for Depression Treatment

Antipsychotic medications for depression when antidepressants fail may not be worth risks

(RxWiki News) One of the most common ways to treat depression is through medication. When the standard medications don't help, doctors may prescribe different or stronger medications. Do they help?

A recent study found the answer to that is a little tricky. Yes, the secondary medications do appear to help reduce depression in patients. However, the patients' overall quality of life does not appear to improve much.

The medications studied in this research all have a variety of side effects. Most of them cause weight gain.

Therefore, doctors and patients must decide whether the possible risks and side effects are worth the small gains possible in treating the depression.

"Ask your doctor about which depression Rx is best for you."

The study, led by Glen I. Spielman, of the Department of Psychology at Metropolitan State University in St. Paul, Minnesota, looked at the effectiveness of a group of medications on overall outcomes of individuals with depression.

The group of medications studied are called adjunctive antipsychotic medications. These medications are different than the selective serotonin reuptake inhibitors (SSRIs) that are commonly given to treat individuals with depression.

Instead, these medications are frequently prescribed to individuals suffering from depression who did not improve after taking an antidepressant by itself.

The researchers reviewed the published and unpublished studies that included trials of these medications against a placebo, or fake pill. They combined the results of all 14 studies they found, and analyzed the effects of the medications.

The studies all ran from four to 12 weeks. They included trials with aripiprazole (Abilify), olanzapine/fluoxetine combination (a combination of Zyprexa and Prozac called Symbyax), quetiapine (Seroquel) or risperidone (Risperdal).

The results showed these medications did offer small or small-to-moderate improvements in the depression symptoms of the patients.

Patients taking aripiprazole were about twice as likely to stop experiencing symptoms of depression. Those taking olanzapine/fluoxetine were about 42 percent more likely to have reduced depression symptoms.

Those taking quetiapine were nearly 80 percent more likely to have reduced depression symptoms, and those taking risperidone were more than twice as likely to have reduced symptoms of depression.

The researchers calculated that 19 patients would need to receive the olanzapine/fluoxetine combination pill in order for one to experience remission from depression. For the other drugs, one person of every nine who were treated with the drug would have reduced symptoms of depression.

Yet when the researchers looked at other outcomes for the patients, including the patients' overall quality of life and ability to function, the benefits from the medications were very small or nonexistent.

In fact, only risperidone showed a very slight improvement in patients' quality of life. The other medications had no effect.

Therefore, even though the medications appeared to help decrease the patents' depression symptoms a little bit, the medications did not seem to make a huge difference overall to the patients' lives.

A small benefit can be a positive outcome, even if it's very small, as long as there are not risks that outweigh it. In the case of these medications, however, a number of side effects present other risks or concerns that patients should consider.

The medications can cause weight gain and restless legs syndrome, for example. They can also lead to abnormal results in lab tests of a person's metabolism, though it's not clear what that might mean. The medications can also lead the patients to feel overly sedated.

"Shortcomings in study design and data reporting may have inflated the apparent benefits of treatment and reduced the apparent incidence of adverse events," the researchers concluded about the clinical trials finding more benefit for patients with these medications.

Ultimately, the researchers concluded that these medications can effectively offer treatment for symptoms of depression.

However, they noted, "clinicians should interpret these findings cautiously in light of (1) the small-to-moderate-sized benefits, (2) the lack of benefit with regards to quality of life or functional impairment, and (3) the abundant evidence of potential treatment-related harm."

The study was published March 12 in the journal PLOS ONE. The research was funded through the Mentored Patient-Oriented Research Career Development Award and the US National Institute of Mental Health. One author is currently involved in a non-industry-funded study testing the effectiveness of aripiprazole. Another author is a consultant in a lawsuit against the manufacturer of aripiprazole.

Two authors are members of an organization called Healthy Skepticism, and two are members of the National Physicians Alliance. One author holds shares of less than $10,000 in a mutual fund (Vanguard Health Care) that invests heavily in pharmaceutical firms. No other conflicts of interest were noted.

Review Date: 
March 12, 2013