Could you combine antipsychotics and antidepressants?

Share on Pinterest
Treatment-resistant depression may require different management and treatment strategies. /Stocksy/Getty Images Marc Tran/Stocksy
  • About 30% of people with major depression have treatment-resistant depression, which means they don’t respond to prescribed first- and second-line antidepressants.
  • While older people are not more likely to have treatment-resistant depression, clinical depression is linked to cognitive decline in this group.
  • It is not clear what the reasons for this are, but they pose a further threat to health and quality of life.
  • A recent study investigated the possibility that the use of antipsychotics alongside antidepressants in people with major depression over the age of 60 could improve outcomes in this group.

While many people who have experienced depression can be treated with antidepressants and talking therapies, a minority of patients do not respond to first- or second-line antidepressants.

These patients are considered to have treatment-resistant depression. Although it is not more prevalent in older people, depression is linked to cognitive decline, although the reasons for the link are not clear.

One path for treatment researchers who have recently been interested in is to see if combining existing antidepressants with other drugs, including other antidepressants, antipsychotics and thyroid hormone medications could help difficult-to-treat forms of depression. especially in older adults.

A recent study published in the New England Journal of Medicine looking at the effect of combining existing antidepressants with an antipsychotic or mood stabilizing drug lithium, compared to antidepressants often used to treat severe and intractable depression.

Prof. David Feifelprofessor emeritus of psychiatry at UC San Diego and founder of the Kadima Neuropsychiatry Institute that specializes in treating patients with treatment-resistant depression, he said. Medical News Today that depression could be a symptom of cognitive decline in older adults, “but it is more likely that cognitive decline is a symptom of depression.”

“Clinical depression is associated with something called ‘pseudo-dementia’, a decline in cognition that is similar to the cognitive decline seen in dementia, but is not due to the progressive brain degeneration that is responsible for dementia and is reversible if the depression is effectively treated,” he explained.

This means that it is particularly important to address treatment-resistant depression in the elderly. There are currently a number of lines of research into what could help.

For example, researchers have investigated the effect of deep brain stimulation, as well as other forms of magnetic and electrical stimulation of different parts of the brain, including electroconvulsive therapy.

The current study, on the other hand, seeks to increase the effects of existing medications.

As part of this study, 619 participants over 60 years old with treatment-resistant depression were divided into three different groups in the OPTIMUM trial.

A group of 211 participants received their normal antidepressants along with the antipsychotic drug aripiprazolea group of 206 participants received their normal antidepressant medication alongside the antidepressant bupropionwhich is often prescribed for severe depression, and the third group of 202 participants received bupropion alone.

Participants took the drug for 10 weeks and had biweekly phone or in-person visits with the clinicians, who adjusted medication levels as needed. Researchers measured the change in psychological well-being that occurred during the treatment period.

The results show that while the participants who received only bupropion had an overall improvement in their well-being of 2.04 points, indicating some improvement, the participants on the other arms of the study saw more benefit.

Participants who stayed on their usual antidepressant medication with the antidepressant bupropion saw an improvement of 4.33 points, and those who took their usual antidepressant medication with the antipsychotic medication aripiprazole saw an improvement of 4.83 points.

About 28.9% of participants who took aripiprazole with their usual antidepressants, and 28.2% of participants who took bupropion with their usual antidepressants saw a remission in their depression. This was only 19.3% in the bupropion only group.

The authors also looked at the effects of lithium, a mood-stabilizing drug when given alongside a participant’s usual antidepressants, compared to swapping the usual antidepressants for nortriptyline, an antidepressant drug.

In a separate study, 127 participants who took lithium in addition to their existing medication saw their well-being scores improve by 3.17 points, and participants who had their antidepressant drug switched to nortriptyline saw an improvement of 2.18 points

About 18.9% of participants who took lithium and 21.5% of those who took nortriptyline went into remission with their depression.

Drugs and risk of falling

The study also collected data on the safety of different drug regimens.

“Surprising [rate of falls was] not worse [with augmentation]. However, there is a higher rate of falling when the second, or augmentation, medication is bupropion vs. [when] is aripiprazole. Thus, aripiprazole is safer as an augmentation with respect to the risk of falling,” lead author Prof. Eric Lenze said MNT.

Professor Feifelwho was not involved in the research, said that antipsychotics have been tested for their effectiveness in people with treatment-resistant depression before.

“Yes, many newer or ‘second-generation’ antipsychotics have been shown to be useful in augmenting or ‘boosting’ the effectiveness of antidepressants, although they generally do not have potent antidepressant effects on their own,” he said.

In addition to oral medication, there are several other potential treatments for treatment-resistant depression. Professor Lenze listed a few:

“In short, there are many options, and almost all people with depression will eventually benefit if they can persist in treatment. These include many medications, psychotherapies (there are also many types of this), and neuromodulation that includes TMS and ECT.

Professor Jordan Karpprofessor and chair in the Department of Psychiatry at the University of Arizona College of Medicine, and one of the authors of the paper, said MNT that the results of the study are encouraging even more work should be done for a more effective treatment.

“These results should make prescribers feel more confident when selecting an antidepressant for their older adults with difficult-to-treat depression. However, the fact that the best treatment only led to a 29% remission rate means that there there is still a lot of work to be done to improve care for depression at the end of life,” he said.

Leave a Comment