30 April 2013

Antipsychotic meds don't help depression

Antipsychotic drugs appear to be only slightly effective and are linked to unwelcome side effects, says a study.


For people who don't fully respond to antidepressants, adding commonly prescribed antipsychotic drugs appear to be only slightly effective and are linked to unwelcome side effects, a new study finds.

Drugs added to antidepressants (like Prozac, Paxil and Celexa) include the antipsychotic medications aripiprazole (Abilify), quetiapine (Seroquel), risperidone (Risperdal) and olanzapine/fluoxetine (Symbyax).

Antipsychotic drugs are traditionally used to treat conditions such as schizophrenia, bipolar disorder and obsessive-compulsive disorder not depression.

"The evidence supporting the use of antipsychotics in depression is marginal," said lead researcher Glen Spielmans, an associate professor in the department of psychology at Metropolitan State University in St. Paul, Minn.

Antipsychotic treatment of depression has become increasingly widespread but the underlying evidence base puts this practice into question, he said.

Mixed results on how effective they are

"Other options may be as effective, or more effective, and carry a lesser side-effect burden," Spielmans said. For instance, cognitive behavioral therapy has been shown to be effective for treatment-resistant depression, he said. Cognitive behavioural therapy is a treatment that helps patients try to change their thoughts, feelings and behaviours.

For one expert, these drugs also aren't a first choice for patients who don't respond fully to antidepressants.

"I have mixed results in terms of how effective they are," said Dr. Bryan Bruno, acting chair of psychiatry at Lenox Hill Hospital, in New York City.

"I treat a lot of patients who are on antidepressants and not responding well. Prescribing these drugs is not something I do often because of the costs and because of the side effects," said Bruno, who was not involved with the study.

Some of these drugs are pricey. For example, Abilify can cost more than $200 (R1 809) a month without insurance, according to the Everyday Health website. With insurance the cost varies by plan.

"I prefer using other strategies like adding other antidepressants, or using brain stimulation treatments, and psychotherapy," Bruno said.

For some patients, however, these antipsychotics can be helpful, including those with insomnia and those whose depression is coupled with a psychosis, he noted.

The report was published in the March issue of the online journal PLoS Medicine.

To gauge the effectiveness of these drugs, Spielmans' team pooled data from 14 studies that compared antipsychotic medications to an inactive placebo in patients for whom antidepressants weren't enough to relieve depression.

This process, called a meta-analysis, attempts to find common threads from different studies that reveal a pattern, which adds information beyond what one study finds.

Small benefit in symptom relief

The new analysis found these drugs offered only a small benefit in relieving symptoms of depression and little or no benefit in improving patients' quality of life or ability to function.

The drugs did, however, have some unwelcome side effects such as restlessness, sleepiness, weight gain and some abnormal lab test results such as increased cholesterol levels, the researchers reported.

Spielmans suggested that some of the trials they looked at may have tried to boost the perception of the effectiveness of the drug and downplay its side effects.

"Studies were sometimes designed in a biased manner that may have slanted the results," Spielmans said. "Data were sometimes reported in a way that likely made the drugs appear more effective than they actually were."

In addition, he said, the researchers found that some side effects were tucked away on the U.S. Food and Drug Administration's website and in clinical trial registries rather than being reported in the published medical journal reports of the studies.

More information

To learn more about depression, visit the U.S. National Institute of Mental Health.

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Depression expert

Michael Simpson has been a senior psychiatric academic, researcher, and Professor in several countries, having worked at London University in the UK; McMaster University in Canada; Temple University in Philadelphia, USA.; and the University of Natal in South Africa.

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