Antipsychotics for psychotic depression? Not such a good idea, according to new research. Adding antipsychotics to antidepressant treatment increased the risk of death and readmission for people diagnosed with psychotic depression.
“Our findings do not indicate that there is no benefit to adding antipsychotics adjunctively to antidepressants as maintenance therapy. “Further research into the effects of antipsychotics during the maintenance phase of psychotic unipolar depression is urgently needed, given the current lack of evidence supporting their benefit,” the researchers wrote. There is.
The study was conducted by Ahmed Al Wangdi and Axel Nordenskjöld of Örebro University in Sweden, and Mikael Landen of Gothenburg University and Karolinska Institutet in Sweden. This research Acta Psychiatry Scandinavica.
The researchers note that it is common to give antipsychotic drugs (in addition to antidepressants) to patients with psychotic depression, and their findings support this. In their study, twice as many people received the combination therapy. In fact, the American Psychiatric Association guidelines for the treatment of psychotic depression list combination therapy, along with electroconvulsive therapy (ECT), as a first-line intervention. Sounds good on the surface, right? If people have “psychosis,” add “antipsychotics.”
But what sounds good on the surface can actually be harmful. The results speak for themselves. After 2 years, 42.3% of those in the combination group were readmitted to the hospital or died by suicide, compared with slightly fewer people in the antidepressant alone group (36.6%). This means that adding antipsychotics did not prevent this outcome and increased the risk.
The researchers used Sweden’s national registry to identify patients hospitalized with a diagnosis of psychotic unipolar depression between 2007 and 2016. Divided into two groups, 1,419 people received antidepressants only and 2,972 people received both antidepressants and antipsychotics.
It could be argued that these results were confounded by other factors such as baseline severity, so the researchers controlled for a variety of factors that may have influenced the results. . Additionally, the researchers found that at baseline, the two groups were more likely to have received ECT during their initial hospitalization (36.4% vs. 26.7%), but the antidepressant-alone group was more likely to have received ECT during their initial hospitalization (36.4% vs. 26.7%). He pointed out that they were similar in terms of aspects. Therefore, in further analyses, the researchers adjusted not only for ECT but also for other possible confounders, including gender, age, previous hospitalization, comorbidities, and other pharmacological treatments. This did not change the results.
In terms of specific outcomes, significantly more people in the combination treatment group were readmitted to the hospital: 35.9% compared with 41.8% in the antidepressant alone group. This undermines the idea that antipsychotics prevent relapse. In fact, it seems more likely that it will happen again.
People in the combination group were also more likely to die from any cause (other than suicide). The rate was 2.4% in the antidepressant-only group, compared with 3.5% in the antidepressant-only group. There was no difference in death by suicide between the two groups.
In a separate analysis, the researchers searched for subgroups of patients for whom the combination therapy actually worked. Nothing found.
But they learned that combination therapy is even more dangerous for young people (18 to 30 years old) than for older people. Youth receiving the combination therapy were approximately twice as likely to experience the primary outcomes of readmission and suicide.
****
Al-Wandi, A., Landen, A. M., and Nordenskjöld, A. (2023). Antipsychotics in the maintenance phase of psychotic depression. Acta Psychiatry Scandinavica. Published online on November 6, 2023. https://doi.org/10.1111/acps.13628 (Full text)
