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Cited 29 time in webofscience Cited 22 time in scopus
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Can Atypical Antipsychotic Augmentation Reduce Subsequent Treatment Failure More Effectively Among Depressed Patients with a Higher Degree of Treatment Resistance? A Meta-Analysis of Randomized Controlled Trialsopen access

Authors
Wang, Hee RyungWoo, Young SupAhn, Hyeong SikAhn, Il MinKim, Hyun JungBahk, Won-Myong
Issue Date
Jun-2015
Publisher
OXFORD UNIV PRESS
Keywords
atypical antipsychotics; augmentation; major depressive disorder; treatment resistance
Citation
INTERNATIONAL JOURNAL OF NEUROPSYCHOPHARMACOLOGY, v.18, no.8, pp 1 - 10
Pages
10
Indexed
SCI
SCIE
SCOPUS
Journal Title
INTERNATIONAL JOURNAL OF NEUROPSYCHOPHARMACOLOGY
Volume
18
Number
8
Start Page
1
End Page
10
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/7850
DOI
10.1093/ijnp/pyv023
ISSN
1461-1457
1469-5111
Abstract
Background: Atypical antipsychotic augmentation was demonstrated to be efficacious in treatment-resistant depression (TRD) in previous meta-analyses. We investigate whether there are differences in the effect size of atypical antipsychotic augmentation in major depressive disorder according to the degree of treatment resistance. Methods: A comprehensive search of four databases identified 11 randomized controlled trials. The 11 trials, which included 3 341 participants, were pooled using a random-effects meta-analysis. Results: Atypical antipsychotic augmentation of antidepressant therapy showed superior efficacy compared to antidepressant monotherapy in TRD in terms of both response and remission rates (response, risk ratio [RR] = 1.38, 95% confidence interval [CI] = 1.25 to 1.53; remission, RR = 1.62, 95% CI = 1.42 to 1.85). In addition, regarding response rates in the TRD trials, atypical antipsychotic augmentation exhibited significantly different effect sizes according to the degree of treatment resistance (TRD 1: RR = 1.24; TRD 2: RR = 1.37; TRD 2-4: RR = 1.58). In non-TRD trials, atypical antipsychotic augmentation failed to show superior efficacy over antidepressant monotherapy in terms of remission rates (RR = 0.89; 95% CI = 0.69 to 1.14). Atypical antipsychotic augmentation of antidepressant therapy exhibits greater effect size in patients with a higher degree of treatment resistance. Conclusions: This finding strengthens the rationale for considering atypical antipsychotic augmentation among depressed patients with multiple previous treatment failures in clinical practice. The efficacy of atypical antipsychotic augmentation for non-TRD seems to be different from that for TRD and, thus, further studies of non-TRD populations are needed.
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