Off-Label Use of Atypical Antipsychotics: An Update
Results: Atypical Antipsychotics for Major Depressive Disorder (1 of 2)
Atypical antipsychotics have been studied for treatment of major depressive disorder (MDD), both as augmentation to selective serotonin reuptake inhibitors (SSRIs) and selective serotonin and norepinephrine reuptake inhibitors (SNRIs) and as monotherapy. Aripiprazole, quetiapine XR, and combination therapy with olanzapine and fluoxetine are FDA approved for MDD.
Remission and response to risperidone were measured with the HAM-D scale. One in every eight patients experience remission attributable to risperidone treatment, defined as a score less than 7 or 8 over two consecutive visits. The strength of evidence for this finding is moderate. One in every seven patients demonstrated response attributable to risperidone treatment, defined as at least a 50-percent reduction in the HAM-D score. The strength of evidence for this finding is moderate.
Quetiapine XR was studied as a monotherapy using the MADRS for outcome assessment. Remission was 1.43-fold the rate achieved with placebo (95-percent confidence interval from 1.07 to 1.91). The response rate was 1.49-fold the rate with placebo (from 1.23 to 1.81). The strength of evidence for these findings is moderate.
Olanzapine was studied as monotherapy, and the response and remission rates were determined based on the MADRS outcomes. No statistically significant difference between placebo and olanzapine monotherapy was found. The strength of evidence for this finding is moderate.
Keywords: antipsychotics | atypical antipsychotics | off-label | second generation | major depressive disorder | MDD | risperidone | ziprasidone | SSRI | SNRI | sertraline | quetiapine XR | olanzapine | fluoxetine | HAM-D | MADRS
- Maglione M, Ruelaz Maher A, Hu J, et al. Off-Label Use of Atypical Antipsychotics: An Update. Comparative Effectiveness Review No. 43 (Prepared by the Southern California RAND Evidence-based Practice Center under Contract No. HHSA 290-2007-10062-I). Rockville, MD: Agency for Healthcare Research and Quality; September 2011. AHRQ Publication No. 11(12)-EHC087-EF. Available at www.effectivehealthcare.ahrq.gov/offlabelantipsych.cfm.
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