Abstract
Background: Previous studies have shown that atypical antipsychotic (AAP) augmentation is effective for treatment-resistant and severe major depressive disorder (MDD). Most treatment guidelines recommend AAP augmentation for treatment of non- or partial-responders to antidepressants (ADs); AAP augmentation is also effective for more severe depression. The effects of ADs usually appear several weeks after initiation of treatment, and AAP augmentation can advance therapeutic responses in some patients. In this study, we performed a naturalistic, retrospective trial to compare early response and remission rates between AD treatment and AAP augmentation in real-life clinical practice.
Methods: A retrospective chart review of patients with MDD without psychotic features and starting treatment for a new major depressive episode was conducted between January 2011 and July 2011. Patients treated with mood stabilizers, conventional antipsychotics, psychostimulants or thyroid hormone augmentation were excluded. Hamilton Depression Rating Scale 17-item (HDRS-17) scores were collected at baseline, 2 weeks and 8±1 weeks after treatment. Response was defined as a ≥50% reduction from baseline HDRS-17 scores; remission was a score of ≤7.
Results: Of 82 patients included, 31 were in the AD group and 51 were in the AAP augmentation group. At 8 weeks, the AD group was taking 1.26±0.51 types of ADs and the AAP augmentation group 1.31±0.54, plus 1.06±0.19 AAPs. At 2 weeks, response was observed in 11 patients (35.48%) in the AD group and 18 patients (35.29%) in the AAP augmentation group (χ2 = 0, p = 1). At week 8, 16 (52.44%) and 27 patients (52.94%) achieved remission (χ2 = 0, p = 1), respectively. However, baseline HDRS-17 total scores were 18.55±5.73 and 22.39±6.14 (t = 2.819, p < 0.01) for the AD and AAP groups, respectively.
Conclusion: Compared with AD treatment, AAP augmentation did not show a more rapid response nor greater remission rates. Considering that the AAP augmentation group had more severe depressive symptoms at baseline, AAP augmentation may be effective in severe MDD.