Question:
In adults with psychotic depression, for how long should antipsychotics be prescribed following remission of symptoms, in improving rates of relapse, readmission rates and physical and social functioning?
Answer:
One,
short term, high quality RCT indicated that treatment with an
antipsychotic in combination with an antidepressant may be more
effective than treatment with an antidepressant alone, in achieving
response and remission of depressive symptoms in hospitalised
patients experiencing a major depressive episode with psychotic
features.1 A follow-up study, which continued the
same medication in those patients who had responded during the
initial RCT, indicated that response was maintained and remission
rates increased over four months in all treatment groups; there
were no significant differences between the groups during
follow-up, i.e. only the difference already observed during the RCT
phase was preserved.2 There were two instances of relapse
during the follow-up study, one in the imipramine group and one in
the venlafaxine combined with quetiapine group.2 We were unable to identify any study
which compared continuation of antipsychotic treatment with
discontinuation for remission, relapse, re-admission rates or
physical and social functioning. No study provided information on
the optimum prescribing duration for antipsychotics as an
augmentation to antidepressants.
More RCTs are needed to establish the optimum prescribing
duration for antipsychotics as an augmentation to antidepressants;
the limited evidence currently available indicates only that
treatment effects can be maintained by continuation of the same
treatment regimen, it provides no information on whether
antipsychotics could be withdrawn after an initial treatment period
without loss of effect. Additional studies are also needed to
establish the relative effectiveness of other combined
antidepressant and antipsychotic treatment options. Trials should
also be conducted in a roader range of relevant populations;
current evidence is limited to a hospitalised population
experiencing an acute episode.