Risperidone, quetiapine, and olanzapine adjunctive treatments in major depression with psychotic features: a comparative study

Abstract

ObjectivesThe purpose of this study was to compare the effectiveness of novel antipsychotics in the treatment of psychotic depression.MethodConsecutive patients who were admitted (n = 51) with a confirmed diagnosis of major depression with psychotic features (delusions or hallucinations or both) participated in this open-label, naturalistic study. All patients were treated with selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) (citalopram or venlafaxine extended release [XR]), and atypical antipsychotic agents were added, as tolerated, during the first week of initiating the citalopram or venlafaxine. There were patients (n = 16) who received risperidone, who received quetiapine (n = 20), and who received olanzapine (n = 15), as an adjunctive treatment to either citalopram or venlafaxine for at least 8 weeks. Outcome measures included the Clinical Global Impression-Severity subscale (CGI-S), as the primary outcome measure, as well as the Hamilton Rating Scale for Depression-21 item (HAM-D21) and the Brief Psychiatric Rating Scale (BPRS). Tolerance to treatments and weight changes were monitored over the period of the trial.ResultsAll patients completed the trial with no drop outs. At 8 weeks, there was a statistically significant (P < 0.001) clinical improvement in all outcome measures for both the depressive and psychotic symptoms, for all three groups of atypical adjunctive treatments. Utilizing analysis of variance (ANOVA), there were no significant differences between the three adjunctive treatment groups in outcome measures. The three antipsychotic agents were equally tolerated. At 8 weeks there was slight increase in weight in the three treatment groups, which was statistically significant (P > .01) in the olanzapine group.ConclusionQuetiapine, risperidone, and olanzapine, given as adjunctive treatment with SSRIS or SNRIs can significantly and equally improve depressive and psychotic symptoms, in the short-term treatment of major depression with psychotic features. The author recommends that large controlled trials be conducted to examine the differences in long-term efficacy and tolerance between the atypical antipsychotic agents, in the treatment of major depression with or without psychotic features.

Medication Adherence and Persistence in Patients with Severe Major Depressive Disorder with Psychotic Features: Antidepressant and Second-Generation Antipsychotic Therapy Versus Antidepressant Monotherapy

“…10 A number of studies have found combination therapy with antidepressants plus second-generation antipsychotics (e.g., olanzapine, quetiapine, aripiprazole, and risperidone) to be effective in achieving a response or remission of depressive episode symptoms in psychotic depression. [14][15][16][17][18][19][20][21] Combination therapy is more beneficial when compared with antipsychotic monotherapy, 16,21 while the results are not as clear when combination therapy is directly compared with antidepressant monotherapy. 14,15,22 For example, a meta-analysis found that combination therapy with an antidepressant plus antipsychotic was superior to antidepressant monotherapy in relation to study-defined inefficacy and Clinical Global Impressions scores.…”

Current approaches to treatments for schizophrenia spectrum disorders, part I: an overview and medical treatments

“…It is generally concluded that there is similar satisfactory clinical efficacy in terms of mental state and global functioning across the FGAs and second-generation antipsychotics 34–37. However, a few trials indicate the superiority of individual second-generation agents over the FGAs in specific illness condition or patient outcomes 29,33,37,38. In two meta-analyses of placebo-controlled trials,39,40 haloperidol was reported to be less effective in reducing symptoms and/or relapse than certain second-generation agents (eg, clozapine and olanzapine).…”

Vagus Nerve Stimulation (VNS) and Other Augmentation Strategies for Therapy-Resistant Depression (TRD): Review of the Evidence and Clinical Advice for Use

“…The FDA has approved both quetiapine and aripiprazole as well as the combination of olanzapine with fluoxetine for augmentation. Other agents include ziprasidone and risperidone, which have also been shown to be effective in treating MDD/TRD (Gabriel, 2013 ; Nelson, 2015 ).…”