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An antidepressant-antipsychotic combination is a frontline strategy for the acute treatment of psychotic depression, but once patients respond, there is no clear-cut long-term strategy, explained study author Alistair Flint, M.B., of the University of Toronto and colleagues. “This is a critical question because premature discontinuation of antipsychotic medication has the risk of relapse of a severe life-threatening disorder. In contrast, the unnecessary continuation of an antipsychotic agent exposes a patient to potentially serious adverse effects.”
For the study, Flint and colleagues relied on data from the second part of a large multistage trial known as The Study of the Pharmacotherapy of Psychotic Depression. The participants included 126 adults aged 18 and older with psychotic depression who had achieved remission or “near remission” of their symptoms following up to 12 weeks of sertraline (150 mg/day to 200 mg/day) and olanzapine (15 mg/day to 20 mg/day) combination therapy. Remission was defined as the absence of delusions and hallucinations as well as a score of 10 or less on the Hamilton Depression Rating Scale (HDRS) for two consecutive weeks; “near remission” was defined as the absence of delusions and hallucinations, an HDRS score of 11 to 15 with a drop in HDRS score of 50% from baseline, and being rated as “very much improved” or “much improved” on the Clinical Global Impression scale.
After remaining on both medications for eight additional weeks, the participants were randomly assigned to either continue their combination therapy of sertraline and olanzapine or have their olanzapine pills switched over to placebo pills over a four-week period. The participants were monitored for up to 36 weeks.
At the end of the trial, 20.3% of patients randomized to olanzapine and 54.8% randomized to placebo experienced at least one relapse. Patients who continued taking olanzapine experienced greater increases in weight gain than those who discontinued olanzapine.
“Relapses resulted in a high frequency of psychiatric hospitalization, highlighting the severity and cost of this disorder and the importance in preventing relapse,” Flint and colleagues wrote.
For related information, see the Psychiatric News article “Benefits of Maintenance Antipsychotics Outweigh Risks, International Panel Concludes.”
(Image: iStock/LumiNola)
