A recent study from Rutgers University and Columbia University has raised concerns about the use of newer antipsychotic medications as an add-on treatment for depression.
Researchers found that adults with depression who started taking these medications had a higher risk of death compared to those who added a second antidepressant to their treatment.
The findings, published in PLOS ONE, underline the importance of cautious use of antipsychotics in treating depression due to their significant potential risks.
Why Antipsychotics Are Used in Depression Treatment
For people with depression, antidepressants are typically the first-choice medication. However, not everyone responds to the initial treatment.
When this happens, doctors often consider other strategies, such as switching to a different antidepressant or adding another medication to boost the treatment’s effectiveness.
Two common augmentation strategies include adding:
- A second antidepressant
- A newer antipsychotic, such as aripiprazole, quetiapine, or olanzapine
These antipsychotic medications are sometimes used to help manage symptoms of depression, particularly in people who don’t respond to standard treatments. However, they come with serious potential side effects.
What the Study Found
The researchers analyzed data from 39,582 adults aged 25 to 64 who were enrolled in Medicaid between 2001 and 2010. After trying a single antidepressant, these patients either added a newer antipsychotic or a second antidepressant to their treatment.
The researchers then linked this data to the National Death Index to track mortality.
Key findings include:
- A 45% higher relative risk of death for those taking newer antipsychotics compared to those who added a second antidepressant.
- This increase translated to one additional death for every 265 people who used a newer antipsychotic for one year.
Why Is This Concerning?
Newer antipsychotics, while sometimes effective, are known to carry significant risks, including weight gain, metabolic issues, and cardiovascular problems.
Previous research has shown that these medications can increase mortality by more than 50% in older adults with dementia. This study now suggests a similar concern for younger adults using these drugs for depression.
The researchers caution that many patients in the U.S. start antipsychotics for depression before fully trying an adequate course of a single antidepressant.
Most antidepressants take 4 to 6 weeks to show their full effect, and prematurely switching to antipsychotics may expose patients to unnecessary risks without exploring safer alternatives.
Implications for Treatment
The study emphasizes that antipsychotics should only be considered after other, less risky treatments have been fully tried and found ineffective. Physicians are encouraged to:
- Carefully weigh the modest benefits of antipsychotics against their substantial risks.
- Avoid prescribing these medications too early in the treatment process.
- Educate patients about the potential side effects and risks of antipsychotics.
While the results are concerning, the study’s authors stress the need for further research. Ideally, large, publicly funded trials could help confirm these findings and better guide treatment decisions.
Until then, doctors and patients should approach the use of antipsychotics for depression with caution.
This research highlights the importance of individualized treatment and careful consideration of risks and benefits. Safer alternatives, such as trying a second antidepressant or other evidence-based strategies, should remain the first choice when initial treatments do not work.
If you care about health, please read studies that scientists find a core feature of depression and this metal in the brain strongly linked to depression.
For more information about health, please see recent studies about drug for mental health that may harm the brain, and results showing this therapy more effective than ketamine in treating severe depression.
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