A Cochrane review [Abstract] 1 included 28 RCTs with 8487 participants with major depression or dysthymia. Twenty-two studies were short-term, up to 12 weeks. Most of the studies included outpatient participants, in all trials the patients were diagnosed with dysthymia or major depression according to DSM-IV or DSM-III.
•Aripiprazole augmentation, when added to antidepressants in major depression: All efficacy data (response OR 0.48; 95% CI 0.37 to 0.63; 3 RCTs, n = 1092), (MADRS MD -3.04; 95% CI -4.09 to -2; 3 RCTs, n = 1077) indicated a benefit for aripiprazole but also more side effects, such as weight gain and extrapyramidal symptoms.
•Olanzapine augmentation and vs. placebo for psychotic depression: When compared to placebo, fewer people discontinued treatment due to inefficacy (OR 0.39; 95% CI 0.18 to 0.86; 2 RCTs, n = 201). When compared to antidepressants olanzapine augmentation showed symptom reduction (MADRS MD -2.84; 95% CI -5.48 to -0.20; 5 RCTs, n = 808), but also more weight or prolactin increase.
•Quetiapine vs. placebo and augmentation for major depression: Quetiapine monotherapy (response OR 0.52; 95% CI 0.41 to 0.66; 3 RCTs, n = 1342) and quetiapine augmentation, when added to antidepressants (response OR 0.68; 95% CI 0.52 to 0.90; 3 RCTs, n = 937) showed symptom reduction, but quetiapine induced more sedation.
•Risperidone augmentation for major depression: Response data was better for risperidone (OR 0.57; 95% CI 0.36 to 0.89; 2 RCTs, n = 371) but augmentation showed more prolactin increase and weight gain.
•Amisulpride vs. placebo for dysthymia: There was a significant difference in response in favour of amisulpride (OR 0.29; 95% CI 0.18 to 0.46; 2 RCTs, n = 322) but patients are more likely to suffer from menstrual disorder and weight gain.
Comment: The quality of the evidence is downgraded by study quality (unclear allocation concealment, short follow-up).
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