Second-generation Antipsychotics in Major Depressive Disorder
Second-generation Antipsychotics in Major Depressive Disorder
Although adjunctive SGAs treatment for the acute treatment of MDD is an advanced treatment option, there are a number of issues to be resolved: proper time to intervention, optimal patient population (presently there is no limitation in this regard), duration of treatment, treatment response and AEs predictors, use of special populations, long-term use treatment, subgroup issues, best-matched antidepressant, dosing issues (especially considering pharmacokinetic and genetic differences between Western and Asian population) and pharmacoeconomic cost/benefit assessment of adjunctive aripiprazole compared with unproven agents on an empirical trial-and-error basis.
Currently available data suggest that SGAs may be a tolerable and effective short-term treatment for patients with MDD who are inadequate responders to antidepressants regardless of the class. In addition, adjunctive quetiapine XR and aripiprazole maintained adequate effectiveness and showed tolerability for a 52-week long-term trial. Adequately powered and well-designed studies will more precisely address clinically valuable and practical information about the use of adjunctive SGAs for treating patients with MDD.
Finally, currently available findings warrant that clinicians consider the potential risk/benefit on a patient-by-patient basis when making a decision to prescribe adjunctive SGAs.
Five-year View
Although adjunctive SGAs treatment for the acute treatment of MDD is an advanced treatment option, there are a number of issues to be resolved: proper time to intervention, optimal patient population (presently there is no limitation in this regard), duration of treatment, treatment response and AEs predictors, use of special populations, long-term use treatment, subgroup issues, best-matched antidepressant, dosing issues (especially considering pharmacokinetic and genetic differences between Western and Asian population) and pharmacoeconomic cost/benefit assessment of adjunctive aripiprazole compared with unproven agents on an empirical trial-and-error basis.
Currently available data suggest that SGAs may be a tolerable and effective short-term treatment for patients with MDD who are inadequate responders to antidepressants regardless of the class. In addition, adjunctive quetiapine XR and aripiprazole maintained adequate effectiveness and showed tolerability for a 52-week long-term trial. Adequately powered and well-designed studies will more precisely address clinically valuable and practical information about the use of adjunctive SGAs for treating patients with MDD.
Finally, currently available findings warrant that clinicians consider the potential risk/benefit on a patient-by-patient basis when making a decision to prescribe adjunctive SGAs.