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Saturday, November 24, 2007

Antipsychotic as Antidepressants?

Recent publications about the use of antipsychotics for depression arise. The Carlat Psychiatry Blog has an excellent article about the most recent antipsychotic: Abilify . I fully agree with his statement:

What is abundantly clear is that drug companies are going to be pushing both psychiatrists and primary care doctors to think of "antipsychotics" as "antidepressants." Look closely at the data before you buy the message!

Recently on this blog I also discussed a publication with negative results of an antipsychotics for depression. This was a case series with clozapine. The study was stopped because of "severely disrupting side effects".

We also discussed the use of antipsychotics for depression without psychotic features.
If there is really an effect it is very small and clinically irrelevant. Moreover it means loosing time before using a more evidence based strategy such as lithium addition. Were looking forward for a comparison between risperidone, lithium and placebo.

Even the use of antipsychotics for psychotic depression has it drawbacks.
Use of antipsychotics especially on the long term is not evidence based. It obscures diagnoses and treatment outcome leading to omission of other effective treatments in order to obtain remission for psychotic depression. There are several effective alternatives for nonresponse or partial response to antidepressants with or without antipsychotics, as can be read in this post with the title: 9 steps for treatment resistant depression

I will certainly keep an eye on this development.

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