Risperidone In , just as aripiprazole was getting limited approval for treating MDD, an important study was published showing similar efficacy for risperidone. Mahmoud and associates4 enrolled patients with MDD from 75 primary care and psychiatric centers. After a 4-week run-in period, patients were randomly assigned to either placebo or risperidone. More risperidone recipients than placebo patients experienced remission of depression Early symptom improvement during the first week of treatment seemed to frequently predict eventual remission.
Adverse effects of headache, somnolence, dry mouth, and weight gain were more common in the risperidone group but did not usually cause dropout from the study. So far, I have not seen any studies reporting on the efficacy of paliperidone the recently marketed risperidone metabolite for treating refractory MDD.
In 6 of 7 short-term studies, quetiapine extended- release, given at doses of 50 to mg, proved effective. Superiority over placebo occurred within the first week of treatment, in marked contrast to the usual delayed response seen with traditional antidepressants. Overall, results were positive in 7 of 8 studies. This compares favorably with most placebo-controlled studies that usually show that antidepressants are better than placebo in only half of the controlled studies.
At the same meeting, there was also discussion of studies trying to establish a role for quetiapine in treating generalized anxiety disorder, where there seemed to be some agreement about efficacy but not safety. Members of the FDA Advisory Committee also noted adverse effects, such as tardive dyskinesia, metabolic changes, and even possibly sudden cardiac death, as worrisome.
Ziprasidone A couple of trials have suggested a positive effect for ziprasidone augmentation in treating refractory MDD.
Conclusion There is emerging evidence supporting the usefulness of atypical antipsychotics in the treatment of MDD.
The studies primarily show effect when atypical antipsychotics are used as add-on agents to traditional SSRIs and SNRIs in patients with refractory depression. So far, quetiapine extended-release and aripiprazole have the best documentation. The effectiveness of relatively low doses and a quick response are both very encouraging findings. What is not yet clear is how long these agents need to be continued and how severe the metabolic weight gain, hyperlipidemia, diabetes , CNS akathisia, parkinsonism, tardive dyskinesia, neuroleptic malignant syndrome , endocrine hyperprolactinemia , and possible cardiac conduction adverse effects will prove to be in patients with MDD.
Until we are better able to quantify the risks with carefully controlled clinical trials assessing the risks and benefits of long-term treatment, it makes sense to keep patient exposure as short as possible.
References 1. Am J Psychiatry. A novel augmentation strategy for treating resistant major depression. The efficacy and safety of ari- piprazole as adjunctive therapy in major depressive disorder: a multicenter, randomized, double-blind, placebo-controlled study. J Clin Psychiatry. Risperidone for treatment-refractory major depressive disorder: a randomized trial.
Ann Intern Med. Nonmedication options include electroconvulsive therapy, transcranial magnetic stimulation, and vagus nerve stimulation. If you decide to try an antipsychotic, our medical advisers suggest that you consult a psychiatrist to help manage the side effects. These materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multi-state settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin gabapentin.
Get Ratings on the go and compare while you shop. Sign In. Become a Member. Remember Me. Forgot username or password? Not a member? Need further assistance? Please call Member Services at Subscribers only Sign in or Subscribe now! Forgot password? Check this box if you wish to have a copy mailed to you. Editor's Note: These materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multi-state settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin gabapentin.
Choose from cars, safety, health, and more! Already signed-up? Manage your newsletters here too. See your savings. Mobile Get Ratings on the go and compare while you shop Learn more.
0コメント