Dr. Zhou and colleagues conducted a meta-analyses on 48 randomized controlled trials (total of 6654 participants) of augmentation agents in adults with treatment-resistant depression. According to the network meta-analysis, the best agents for augmentation therapy were quetiapine, aripiprazole, thyroid hormone, and lithium. Although thyroid hormone and lithium are better tolerated, they seem to be less efficacious than quetiapine and aripiprazole. The authors acknowledge that further studies comparing these augmentation agents head-to-head and addressing the limitations of previous studies (e.g., longer duration, dosing, sample size, study design, financial bias) will be required to confirm these results. In a commentary, Dr. Richard Shelton discusses about the limitations of meta-analyses and suggests interpreting these results with caution.
Burnout is a state of emotional exhaustion related to chronic stress from work or personal issues. Madsen and colleagues found that burnout is associated with an increased risk of antidepressant treatment in 2936 Danish human service workers. As noted by the authors, these results suggest that individuals with high levels of burnout are at substantial risk of developing a clinically significant mental health condition that may require antidepressant treatment.
In the November 2014 issue of BMC Psychiatry, David Veale and colleagues from King’s College in London conducted a meta-analysis of the clinical effectiveness of adding atypical anti-psychotics (aripiprazole, olanzapine, quetiapine, or risperidone) to Selective Serotonin Reuptake Inhibitor (SSRI) antidepressants (e.g., fluoxetine, fluvoxamine, citalopram) in treatment-resistant patients with Obsessive Compulsive Disorder (OCD) . They found limited evidence for using a low dose of risperidone or aripiprazole and no evidence for using olanzapine or quetiapine. They suggest considering other augmentation strategies such as combining the SSRI antidepressant with cognitive-behavioral therapy or clomipramine.
Individuals with borderline personality disorder (BPD) suffer from mood instability, impulsive behavior, and disturbed relationships. Although studies suggest a beneficial effect of psychotherapy in BPD, results of medication studies have been mixed. In the October issue of the American Journal of Psychiatry, Dr. Donald Black and colleagues conducted a 8-week double-blind study comparing quetiapine, a second-generation antipsychotic, with placebo in 95 individuals diagnosed with BPD. They found that a low dose of quetiapine (150 mg daily) reduced the symptom severity of BPD. In their conclusion, the authors urged for longer and additional studies to confirm the effectiveness of quetiapine in this disorder.
In a video, Dr. Helen Blair Simpson discusses her study published in JAMA Psychiatry comparing Exposure and Ritual Prevention Cognitive-Behavioral Therapy (CBT), risperidone, and placebo in OCD patients treated with selective serotonin reuptake inhibitor antidepressants (SSRI’s). CBT had better outcomes than risperidone and placebo. Dr. Simpson suggests discontinuing antipsychotic medications in SSRI-treated OCD patients who do not improve after four weeks.
In a previous post (10/2/14), I reported a study suggesting that physical activity improves depression. In a new study published in the October 15 issue of JAMA Psychiatry, Drs. Snehal M. Pinto Pereira, Marie-Claude Geoffroy, and Christine Power suggest a bidirectional relationship between depression and physical activity, i.e., physical activity may decrease depressive symptoms and, in turn, depressive symptoms in early adulthood may be an impediment to physical activity.
In the October issue of the American Journal of Psychiatry, Alexander Viktorin and colleagues identified 3240 subjects with bipolar disorders treated for a depressive episode. There was a marked increase in the risk of treatment-emergent mania in patients who were not treated with a concurrent mood stabilizer. These results confirm previous guidelines about not using antidepressants as monotherapy in the treatment of bipolar disorder. In an editorial, Dr. Eduard Vieta suggests that “Every patient should have the right to receive a detailed summary of reasonable treatment choices, psychoeducation on the illness, and objective information on the benefits and risks of each strategy. For many patients, antidepressants will not be the first-line recommendation, but perhaps those with a depressive-predominant polarity, with bipolar II disorder, or with a previous response to antidepressants may be candidates for an adjunctive antidepressant.” For those who want to know more about bipolar disorder, ‘Crash Course‘ produced a very informative (and entertaining) video on You Tube.