Long-term response to successful acute pharmacological treatment of psychotic depression

Wijkstra, Jaap; Burger, Huibert; Broek, Walter W. van den; Birkenhäger, Tom K.; Janzing, J.G.E.; Boks, Marco P.; Bruijn, Jan A.; Loos, Marc; Breteler, Leonie M.T.; Verkes, Robbert J.; Nolen, Willem A.

doi:10.1016/j.jad.2009.10.014

Cited by 24 publications

(23 citation statements)

References 13 publications

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“…Of these 54 articles, 10 articles reported on acute randomized controlled trials comparing either AD+AP versus AD or AD+AP versus AP treatment in patients with major depressive disorder with psychotic features. One additional article 19 reported on the maintenance efficacy of AD+AP versus AD in a 4-month, open label extension study of a 7-week, acute phase study. 7 Additional searches of the Cochrane Library, yielding 326 Cochrane reviews, 60 “other reviews,” and 482 clinical trials, and of PsychINFO, yielding 666 initial hits, did not uncover any additional relevant articles/studies.…”

Section: Resultsmentioning

confidence: 99%

Are Antipsychotics or Antidepressants Needed for Psychotic Depression?

Farahani¹,

Correll²

2012

J. Clin. Psychiatry

119

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Objective To perform a meta-analysis of antidepressant-antipsychotic cotreatment versus antidepressant or antipsychotic monotherapy for psychotic depression. Data Sources We performed an electronic search in PubMed/Medline, Cochrane Library and PsycINFO from inception of the data bases until 02/20/2012, without language/time restrictions. Key words were: (psychosis OR psychotic OR hallucinations OR hallucinating OR delusions or delusional) AND (depression OR depressed OR major depressive disorder) AND (random OR randomized OR randomly). Study Selection Eight randomized, placebo-controlled acute phase studies (n=762) in adults with standardized criteria-defined psychotic depression were meta-analyzed, yielding 10 comparisons. Antidepressant-antipsychotic cotreatment was compared in 5 trials with 6 treatment arms (n=337) with antidepressant monotherapy and in 4 trials and treatment arms (n=447) with antipsychotic monotherapy. Data Extraction Primary outcome was study-defined inefficacy; secondary outcomes included all-cause discontinuation, specific psychopathology ratings and side effects. Using random effects models, we calculated risk ratios (RR) with 95% confidence intervals (CI), numbers-needed-to-treat/harm (NNT/NNH) and effect sizes (ES). Results Antipsychotic-antidepressant co-treatment outperformed antidepressant monotherapy regarding less study-defined inefficacy (N=6, n=378, RR:0.76, CI:0.60,0.96, p=0.03, I2=34%; NNT=7, CI:4-20, p=0.009) and Clinical Global Impressions-Severity (N=4, n=289, ES:-0.25, CI:-0.49,-0.02, p=0.03, I2=0%), with trend-level superiority for depression ratings (N=5, n=324, ES:-0.20, CI:-0.44,0.03, p=0.09, I2=10%), but not psychosis (N=3, n=161, ES:-0.24, CI:-0.85,0.38, p=0.45, I2=70%). Antidepressant-antipsychotic co-treatment also outperformed antipsychotic monotherapy regarding less study-defined inefficacy (N=4, n=447, RR:0.73, CI:0.63,0.84, p<0.0001, I2=0%; NNT=5, CI:4-8, p<.0001) and depression (N=4, n=428, ES:-0.49, CI:-0.75,-0.23, p=0.0002, I2=27), while anxiety (p=0.11) and psychosis ratings (p=0.06) only trended favoring co-treatment. All-cause-discontinuation and reported side effect rates were similar, except for more somnolence with antipsychotic-antidepressant co-treatment versus antidepressants (p=0.02). Only one open, 4-month extension study (n=59) assessed maintenance/relapse prevention efficacy of antidepressant-antipsychotic cotreatment versus antidepressant monotherapy, without group differences. Conclusions Antidepressant-antipsychotic cotreatment was superior to monotherapy of either class in the acute treatment of psychotic depression. These results support recent treatment guidelines, but more studies are needed to assess specific combinations and maintenance/relapse prevention efficacy.

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Section: Resultsmentioning

confidence: 99%

Are Antipsychotics or Antidepressants Needed for Psychotic Depression?

Farahani¹,

Correll²

2012

J. Clin. Psychiatry

119

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“…Both depression and psychosis are prevalent in dementia [48,49], but this is the first study showing that dementia is associated with a relative increased risk of the psychotic rather than the non-psychotic subtype of depression. Consequently, when assessing depression in patients with dementia, clinicians must be attentive to psychotic symptoms, which may have consequences for the choice of treatment when present [50,51]. Conversely, clinicians treating PD should be aware of a potential comorbid dementia, which may require specific care of its own in addition to the treatment of the depression.…”

Section: Discussionmentioning

confidence: 99%

The Association between Physical Morbidity and Subtypes of Severe Depression

Østergaard

Petrides

Dinesen

et al. 2012

Psychother Psychosom

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Background: Physical illness and depression are related, but the association between specific physical diseases and diagnostic subtypes of depression remains poorly understood. This study aimed to clarify the relationship between a number of physical diseases and the nonpsychotic and psychotic subtype of severe depression. Methods: This is a historical prospective cohort study. The study population consisted of all patients diagnosed with ICD-10 severe depression, either nonpsychotic or psychotic subtype, in Danish psychiatric hospitals between 1994 and 2008. The patients’ history of physical disease was assessed using the Danish National Patient Register. Using logistic regression it was investigated whether specific physical diseases were associated with relative increased risk for subsequent development of either the nonpsychotic or psychotic depressive subtype. Results: A total of 24,173 patients with severe depression were included in the study. Of those, 8,260 (34%) were of the psychotic subtype. A history of the following physical diseases, as opposed to their absence, increased the relative risk for subsequent development of the nonpsychotic compared to the psychotic depressive subtype [adjusted incidence odds ratio (AIOR) nonpsychotic vs. psychotic]: ischemic heart disease (AIOR = 1.3, p < 0.001), hypertension (AIOR = 1.2, p = 0.008), stroke (AIOR = 1.2, p = 0.042) and chronic lower pulmonary disease (AIOR = 1.2, p = 0.005). The total load of physical disease also increased the relative risk of nonpsychotic depression [AIOR = 1.05 (per disease), p = 0.001]. Conclusions: This study revealed that, in severe depression, a history of physical disease increased the relative risk of the nonpsychotic rather than the psychotic subtype.

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“…Wijkstra and colleagues 89 reported on a 4-month open-label follow-up of 59 patients with DSM-IV-TR major depressive disorder with psychotic features, aged 18-65 years, who had completed as responders an acute double-blind, 7-week trial with imipramine, venlafaxine, or venlafaxine plus quetiapine. Relapse rate was low (3.8%; 2/53).…”

Section: Treatment Of Psychotic Depressionmentioning

confidence: 99%

Challenges in the Treatment of Major Depressive Disorder With Psychotic Features

Rothschild¹

2013

Schizophrenia Bulletin

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Psychotic depression is associated with significant morbidity and mortality but is underdiagnosed and undertreated. In recent years, there have been several studies that have increased our knowledge regarding the optimal treatment of patients with psychotic depression. The combination of an antidepressant and antipsychotic is significantly more effective than either antidepressant monotherapy or antipsychotic monotherapy for the acute treatment of psychotic depression. Most treatment guidelines recommend either the combination of an antidepressant with an antipsychotic or ECT for the treatment of an acute episode of unipolar psychotic depression. The optimal maintenance treatment after a person responds to either the antidepressant/antipsychotic combination or the ECT is unclear particularly as it pertains to length of time the patient needs to take the antipsychotic medication. Little is known regarding the optimal treatment of a patient with bipolar disorder who has an episode of psychotic depression or the clinical characteristics of responders to medication treatments vs ECT treatments.

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Long-term response to successful acute pharmacological treatment of psychotic depression

Cited by 24 publications

References 13 publications

Are Antipsychotics or Antidepressants Needed for Psychotic Depression?

Are Antipsychotics or Antidepressants Needed for Psychotic Depression?

The Association between Physical Morbidity and Subtypes of Severe Depression

Challenges in the Treatment of Major Depressive Disorder With Psychotic Features

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