In a recent study at Rutgers and Columbia University, researchers found an increased death risk in adults with depression who used newer antipsychotic medications compared to people who used a different antidepressant.
The study is published in PLOS ONE. One author is Tobias Gerhard.
Although antidepressants are the first-line treatment for depression, many people do not respond to the first course of treatment.
Subsequent treatment options include switching to another antidepressant followed by various strategies, including using newer antipsychotics, such as aripiprazole, quetiapine, and olanzapine.
Antipsychotics have well-recognized and often serious adverse effects, including a more than 50% increased death risk in older adults with dementia.
It had been unknown whether this death risk applies to adults using newer antipsychotics as a treatment for depression.
In the study, the team analyzed data of 39,582 Medicaid beneficiaries ages 25 to 64 from 2001 to 2010.
After a period of treatment with a single antidepressant drug, study patients started to use a newer antipsychotic or a second antidepressant.
The researchers found a 45% increase in death risk for those using a newer antipsychotic.
The finding suggests that doctors should consider prescribing antipsychotics to adults with depression carefully, as the potential health risks are strong and the benefits are quite modest and controversially debated.
However, contrary to the drug label and treatment guidelines, many patients in the United States start antipsychotic treatment for depression without having completed an adequate prior trial with a single antidepressant.
The team says these results emphasize the importance of considering newer antipsychotics only after non-response to less risky, evidence-based treatment options have been found.
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