In a recent study from Rutgers University, researchers found adults with depression who added newer antipsychotic medications to their treatment had an increased mortality risk compared to a control group that added a second antidepressant.
They suggest physicians managing adults with depression should be aware of this potential for increased mortality.
Although antidepressants are the first-line pharmacological treatment for depression, many people don’t respond to the first course of treatment.
Subsequent treatment options include switching to another antidepressant followed by various augmentation strategies, including prescribing a second antidepressant and newer antipsychotics, such as aripiprazole, quetiapine, and olanzapine.
Antipsychotics have well-recognized and often serious adverse effects, including a more than 50% increased mortality risk in older adults with dementia.
In the study, researchers looked at data of 39,582 Medicaid beneficiaries ages 25 to 64 from 2001 to 2010, linked to the National Death Index.
After a period of treatment with a single antidepressant, study patients received prescriptions for a newer antipsychotic or a second antidepressant.
The researchers found a 45% increase in mortality risk for those initiating a newer antipsychotic, which for the study cohort translated to one additional death for every 265 people taking the antipsychotic for one year.
The study suggests that physicians should consider prescribing antipsychotics to adults with depression carefully, as the potential health risks are substantial and the benefits are quite modest and controversially debated.
It emphasizes the importance of considering newer antipsychotics only after non-response to less risky, evidence-based treatment options has been established.
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The study is published in PLOS ONE. One author of the study is Tobias Gerhard.
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