In a new study published in the journal PLOS ONE, researchers found an increased mortality risk in adults with depression who initiated augmentation with newer antipsychotic medications.
The study was from Rutgers. One author is Tobias Gerhard.
Although antidepressants are the first-line pharmacological 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 augmentation strategies, including augmentation with a second antidepressant and augmentation with newer antipsychotics, such as aripiprazole, quetiapine and olanzapine.
The team says antipsychotics have well-recognized and often serious adverse effects, including a more than 50 percent increased mortality risk in older adults with dementia.
It had been previously unknown whether this mortality risk applies to non-elderly adults using newer antipsychotics as an augmentation treatment for depression.
In the study, the team analyzed 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 initiated either augmentation with a newer antipsychotic or with a second antidepressant.
The researchers found a 45% relative 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 results suggest that doctors 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.
The team says it is well-known that most antidepressants take about four to six weeks to be fully effective.
However, contrary to the drug label and treatment guidelines many patients in the United States initiate antipsychotic treatment for depression without having completed an adequate prior trial with a single antidepressant.
The current results emphasize the importance of considering newer antipsychotics only after non-response to less risky, evidence-based treatment options has been established.
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