Efficacy and safety of olanzapine/fluoxetine combination in the treatment of treatment-resistant depression: a meta-analysis of randomized controlled trials

Luan, Shuxin; Wan, Hongquan; Wang, Shijun; He, Li; Zhang, Baogang

doi:10.2147/ndt.s127453

Cited by 25 publications

(20 citation statements)

References 33 publications

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“…The MPG recommended OFC as a first-line option, stating that it is well researched and generally well tolerated, and suggested that olanzapine augmentation of a TCA may also be effective, as may olanzapine monotherapy ( Takahashi et al, 2008 ). The MPG highlighted the risk of weight gain and limited clinical experience outside the United States and the fact that most available data are related to bipolar disorder ( Luan et al, 2017 ).…”

Section: Resultsmentioning

confidence: 99%

Pharmacological Augmentation in Unipolar Depression: A Guide to the Guidelines

Taylor

Marwood

Oprea

et al. 2020

International Journal of Neuropsychopharmacology

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Background Pharmacological augmentation is a recommended strategy for patients with treatment-resistant depression. A range of guidelines provide advice on treatment selection, prescription, monitoring and discontinuation, but variation in the content and quality of guidelines may limit the provision of objective, evidence-based care. This is of importance given the side effect burden and poorer long-term outcomes associated with polypharmacy and treatment-resistant depression. This review provides a definitive overview of pharmacological augmentation recommendations by assessing the quality of guidelines for depression and comparing the recommendations made. Methods A systematic literature search identified current treatment guidelines for depression published in English. Guidelines were quality assessed using the Appraisal of Guidelines for Research and Evaluation II tool. Data relating to the prescription of pharmacological augmenters were extracted from those developed with sufficient rigor, and the included recommendations compared. Results Total of 1696 records were identified, 19 guidelines were assessed for quality, and 10 were included. Guidelines differed in their quality, the stage at which augmentation was recommended, the agents included, and the evidence base cited. Lithium and atypical antipsychotics were recommended by all 10, though the specific advice was not consistent. Of the 15 augmenters identified, no others were universally recommended. Conclusions This review provides a comprehensive overview of current pharmacological augmentation recommendations for major depression and will support clinicians in selecting appropriate treatment guidance. Although some variation can be accounted for by date of guideline publication, and limited evidence from clinical trials, there is a clear need for greater consistency across guidelines to ensure patients receive consistent evidence-based care.

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Section: Resultsmentioning

confidence: 99%

Pharmacological Augmentation in Unipolar Depression: A Guide to the Guidelines

Taylor

Marwood

Oprea

et al. 2020

International Journal of Neuropsychopharmacology

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“…Where the illness has not responded sufficiently to antidepressant medication, a further pharmacological strategy that is recommended in treatment guidelines for depression is the addition of an antipsychotic medication. 1,3,12 There is most evidence to support the use of quetiapine, 21 olanzapine, 22 aripiprazole, 23 or risperidone. 24 We found that augmentation with one of these four antipsychotic medications was the most common pharmacological strategy employed in routine clinical practice in mental health services, being used in a third of those with moderate depression and two-thirds of those with severe depression.…”

Section: Discussionmentioning

confidence: 99%

Prescribing for moderate or severe unipolar depression in patients under the long-term care of UK adult mental health services

Paton

Anderson

Cowen

et al. 2020

Therapeutic Advances in Psychopharmacology

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Background: A quality improvement programme addressing prescribing practice for depression was initiated by the Prescribing Observatory for Mental Health. Methods: A baseline clinical audit against evidence-based practice standards was conducted in UK adult mental health services. Results: A total of 55 mental health services submitted data for 2082 patients, under the care of a community psychiatric team (CMHT) for at least a year, with a diagnosis of moderate or severe unipolar depression, 54% of whom had a comorbid psychiatric diagnosis. Selective serotonin reuptake inhibitors were prescribed for 35% of the patients, other newer generation antidepressants for 60%, tricyclic antidepressants for 6% and monoamine oxidase inhibitors for <1%. The most commonly prescribed individual antidepressants were mirtazapine (33%, usually in combination with another antidepressant), venlafaxine (25%) and sertraline (21%). Patients with severe depression were more likely ( p < 0.001) to be co-prescribed an antipsychotic medication, lithium, or to have received electroconvulsive therapy. There was a documented clinical review in the last year in 85%, with a symptom rating scale used in 11%. A documented comprehensive treatment history was accessible for 50% of those prescribed antidepressant medication. Conclusion: Patients with moderate or severe depression remaining under the care of a CMHT for longer than a year are clinically complex. The failure to achieve a level of wellness allowing discharge from mental health services may be partly related to the finding that not all patients had the benefit of a systematic approach to clinical assessment and sequential testing of available evidence-based pharmacological interventions.

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“…As there is strong evidence for the efficacy of combination or augmentation psychotropic therapy for treatment‐resistant depression, 38,39 polypharmacy of psychotropics is sometimes used for individuals with severe mental conditions. However, inappropriate prescribing of psychotropics has become a worldwide problem 40‐42 .…”

Section: Discussionmentioning

confidence: 99%

Association between psychotropic prescriptions and the total amount of psychotropics ingested during an intentional overdose: A single‐center retrospective study

Tanahashi

Shiganami

Iwayama

et al. 2022

Neuropsychopharm Rep

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Aim:To investigate the association between psychotropic prescriptions and the total amount of psychotropics ingested during a subsequent intentional overdose and to examine factors related to the number of psychotropic prescriptions. Methods:The initial sample comprised 69 patients who were admitted to the emergency department of a general hospital in Japan following an intentional overdose via psychotropic medications. We performed retrospective hierarchical multiple regression analysis with the total amount of psychotropics ingested at the overdose as a dependent variable and factors related to deliberate self-harm or overdose identified in previous studies as independent variables. We compared two models, one that did not (Step 1) and one that did (Step 2) include the number of different prescribed psychotropic medications as an independent variable in the analysis.Results: Forty-seven patients were eligible for the analysis. The number of different prescribed psychotropic medications was associated with the total amount of psychotropics ingested at the overdose in Step 2 (β = 0.40, P = .01). There was a trend toward an association between the past number of deliberate self-harm events and the total amount of psychotropics ingested at the overdose in Step 1 (β = 0.30, P = .05), but this trend was weakened in Step 2 (β = 0.15, P = .33). Conclusion:The number of different prescribed psychotropics appeared to influence the risk of subsequent intentional overdose through increasing the total amount of psychotropics ingested. Cumulative psychotropic prescriptions, particularly those delivered after deliberate self-harm, might be indirectly related to this risk.

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Efficacy and safety of olanzapine/fluoxetine combination in the treatment of treatment-resistant depression: a meta-analysis of randomized controlled trials

Cited by 25 publications

References 33 publications

Pharmacological Augmentation in Unipolar Depression: A Guide to the Guidelines

Pharmacological Augmentation in Unipolar Depression: A Guide to the Guidelines

Prescribing for moderate or severe unipolar depression in patients under the long-term care of UK adult mental health services

Association between psychotropic prescriptions and the total amount of psychotropics ingested during an intentional overdose: A single‐center retrospective study

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