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Adding atypical antipsychotic improves depression scores by 45%, says NHS analysis

Patients with treatment-resistant depression may have better outcomes if they are also given an atypical antipsychotic, suggests an NHS-funded analysis.

The health technology assessment found that adding an atypical antipsychotic to treatment with an SSRI resulted in an average improvement in depression scores of 48%.

The meta-analysis also found some evidence from one study that adding lithium to SSRI treatment could also be beneficial, with lithium plus SSRI treatment more cost effective than SSRI/atypical antipsychotic treatment, but with the difference in depression scores overall judged as non-significant.

The analysis, published in the journal Health Technology Assessment, looked at eleven RCTs where add-on treatments have been used to tackle unipolar treatment-resistant depression.

Six out of ten studies compared fluoxetine treatment with or without olanzapine and found combination treatment improved depression scores by 45%, as measured by the Montgomery-Asberg Depression Scale (MADRS)or Hamilton Depression Scale.

But the researchers said the results were ‘moderately heterogeneous’ and that a further four studies found little mean difference from baseline depression with the addition of olanzapine.

The authors concluded: ‘The results of this review support the conclusion that augmentation of SSRIs with lithium or an atypical antipsychotic is likely to be beneficial in people with treatment-resistant depression, defined as a failure to respond to two or more antidepressants in the current episode of depression.’

‘However, based on the limited number of RCTs identified, the clinical evaluation suggests there is no statistically significant difference between the two augmentation strategies’