For individuals who do not completely respond to antidepressants, including generally prescribed antipsychotic drugs seems to be only slightly powerful and is linked to unwelcome side effects, a new study finds.
Drugs added to antidepressants (like Prozac, Paxil and Celexa) comprise the antipsychotic medications aripiprazole (Abilify), quetiapine (Seroquel), risperidone (Risperdal) and olanzapine/fluoxetine (Symbyax).
Antipsychotic drugs are used to take care of ailments such as bipolar disorder, schizophrenia and obsessive-compulsive disorder — not depression.
“The evidence supporting the use of antipsychotics in melancholy is marginal,” said lead researcher Glen Spielmans, an associate professor in the department of psychology at Metropolitan State University in St. Paul, Minn.
Antipsychotic treatment of depression has gotten increasingly widespread but the underlying evidence base puts this practice he said.
“Other choices may be as powerful, or even more successful, and carry a lesser side effect weight,” Spielmans said. For example, cognitive behavioral therapy was demonstrated to be effective for treatment-resistant depression, he said. Cognitive behavioral therapy is a treatment that helps patients try and modify their thoughts, behaviors and feelings.
For one pro, these drugs also aren’t a first pick for patients who do not react fully to antidepressants.
“I ‘ve mixed results when it comes to how powerful they are,” said Dr. Bryan Bruno, acting chair of psychiatry at Lenox Hill Hospital, in New York City.
“I treat a lot of patients who are on antidepressants and not responding well. Prescribing these drugs isn’t something I do often due to the prices and because of the side effects,” said Bruno, who wasn’t involved with the study.
A few of these drugs are pricey. For instance, Abilify can cost more than $200 a month without insurance, according to the Everyday Health web site. By plan the cost varies with insurance.
“I prefer using other strategies like adding other antidepressants, or using brain stimulation treatments, and psychotherapy,” Bruno said.
For many patients these antipsychotics may be helpful, including those whose depression is coupled using a psychosis and individuals with sleeplessness, he noted.
The report was published in the March issue of the online journal PLoS Medicine.
To gauge the effectiveness of those drugs, Spielmans’ team pooled data from 14 studies that compared antipsychotic medications for whom antidepressants weren’t enough to relieve depression in patients to an inactive placebo.
This process, called a meta-analysis, attempts to find common threads from different studies that reveal a pattern, which adds advice beyond
The newest analysis found merely a small benefit was offered by these drugs in alleviating symptoms of melancholy and little or no advantage in improving patients’ quality of life or power to operate.
The drugs did, nevertheless, have some unwelcome side effects such as sleepiness, restlessness, weight gain plus some abnormal lab test results including increased cholesterol levels, the researchers reported.
Spielmans suggested that some of the trials they looked at may have tried to boost the awareness of the effectiveness of the drug and downplay its side effects.
“Studies were occasionally designed in a one-sided manner that may have slanted the results,” Spielmans said. “Data were sometimes reported in a way that likely made the drugs seem more effective than they really were.”
In addition, he explained, the researchers found that some side effects were tucked away on the U.S. Food and Drug Administration’s site and in clinical trial registries rather than being reported in the published medical journal reports of the studies.
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