A study conducted by researchers from Rutgers University and Columbia University has uncovered a troubling link between the use of newer antipsychotic medications and an increased risk of mortality in adults with depression.
The findings, published in the journal PLOS ONE by Tobias Gerhard and colleagues, suggest that adults who add antipsychotic medications to their treatment regimen may face a significantly higher risk of death compared to those who opt for a second antidepressant instead.
Depression is a common mental health condition, and while antidepressants are typically the first line of treatment, not everyone responds to the initial course of medication. For those who do not improve, doctors often consider additional treatment strategies.
These include either switching to a different antidepressant or augmenting the initial treatment with another drug. Augmentation strategies can involve adding a second antidepressant or newer antipsychotic medications, such as aripiprazole, quetiapine, or olanzapine.
Antipsychotics, though effective for some, are known to come with significant side effects. These include a well-documented increase in mortality risk, particularly in older adults with dementia.
The new study aimed to explore whether this elevated risk extends to younger adults with depression who are prescribed these medications.
The researchers analyzed data from 39,582 Medicaid beneficiaries aged 25 to 64, collected between 2001 and 2010. The data was linked to the National Death Index, allowing the team to track mortality outcomes.
The study participants were divided into two groups: those who added a newer antipsychotic to their treatment after not responding to a single antidepressant, and those who instead added a second antidepressant.
The results were concerning. The study found that individuals who initiated treatment with a newer antipsychotic faced a 45% relative increase in mortality risk compared to those who added a second antidepressant.
For the study cohort, this increased risk translated to one additional death for every 265 people treated with an antipsychotic for one year.
Given these findings, the researchers urge caution when considering antipsychotics for treating depression, especially since the benefits of these medications are modest and have been the subject of ongoing debate.
The study also highlights a critical issue in current medical practice: many patients in the United States begin antipsychotic treatment for depression without completing an adequate trial of a single antidepressant, contrary to drug labels and treatment guidelines.
Antidepressants typically take about four to six weeks to show full effectiveness, yet some patients are moved to antipsychotic medications prematurely.
The study’s authors emphasize the need for physicians to carefully weigh the risks and benefits of prescribing antipsychotics to adults with depression. They recommend considering these medications only after less risky, evidence-based options have been exhausted.
The results underscore the importance of prioritizing safer treatment strategies, particularly when the potential health risks of antipsychotics are substantial.
While the findings of this study are significant, the researchers also call for further research to confirm these results, ideally through a publicly funded randomized controlled trial.
In the meantime, this study serves as a crucial reminder for both doctors and patients to carefully consider treatment options for depression, with an emphasis on minimizing risks while striving for effective outcomes.
If you care about mental health, please read studies about how dairy foods may influence depression risk, and 6 foods you can eat to improve mental health.
For more mental health information, please see recent studies about top foods to tame your stress, and Omega-3 fats may help reduce depression.
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