Efficacy of Risperidone Augmentation to Antidepressants in the Management of Suicidality in Major Depressive Disorder

Augmentation Treatments with Second-generation Antipsychotics to Antidepressants in Treatment-resistant Depression

“…Mahmoud et al [24] found that S16total endpoint scores on the 17-item HAM-D were significantly lower for the risperidone augmentation group (13.4) compared with the placebo group (16.2) in a 6-week study (n = 274). Reeves et al [25] observed no significant difference between risperidone and placebo augmentation in the severity of suicidality as assessed by the Beck Scale for Suicide Ideation, which was the primary endpoint of this 8-week, small-sample (n = 23) study. Furthermore, the mean MADRS score change at study endpoint was not statistically significant between the risperidone (-22.1) and placebo group (-14.4).…”

“…Thase et al [18] includes two trials (study 1 and study 2). Response was defined as an improvement of C50% from baseline to endpoint on the HAM-D or the MADRS, and remission was defined as a MADRS total score of B10 and C50% reduction in MADRS total score in the trials except trials by Shelton et al [15] and Corya et al [17] (two subsequent MADRS total score B8), McIntyre and Gendron [22] and Mahmoud et al [24] (HAM-D-17 score B7), Bauer et al [20], El-Khalili et al [21] and Keitner et al [26] (MADRS total score B8), trial by Reeves et al [25] aripiprazole than receiving placebo (0.6 %) had a weight gain of 7 % or more [13]. The difference in weight gain with SGA adjunctive therapy was small, and no other adverse event related to metabolic function, such as changes in mean waist circumference, total cholesterol, high or low-density lipoprotein cholesterol, triglycerides, fasting plasma glucose, or haemoglobin A1C, was associated with aripiprazole augmentation in short-term trials.…”

“…Three double-blind RCTs [24][25][26] investigated the effects of risperidone augmentation in conjunction with various antidepressant therapies in patients with TRD (Table 2). In those trials, risperidone was initiated at 0.25-1 mg/day, and the dose was titrated to a maximum of either 2 or 3 mg/day, with a mean dose of 1-2 mg/day at the end of the studies.…”

“…1). The data were extracted from nine studies that had all data for the rate of remission, discontinuation due to adverse events and most common adverse effects in each SGA [7,9,19,[22][23][24][25][26]. As for treatment efficacy, the NNT was six for risperidone, eight for aripiprazole, nine for quetiapine and 13 for olanzapine.…”

“…1 The number needed to treat (remission rate) and number needed to harm (rates of discontinuation due to adverse events and most common side effects) of each drug (%). Pooled data from controlled trials of olanzapine [19], risperidone [24][25][26], quetiapine [20,22], aripiprazole [7][8][9]. The Cochran data [6] and data in a metaanalysis [5] were referred.…”