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Eur Neuropsychopharmacol. 2018 Dec;28(12):1305-1313. doi: 10.1016/j.euroneuro.2018.10.003. Epub 2018 Nov 13.

Clinical factors associated with augmentation treatment with second-generation antipsychotics and lithium in major depression - Results from a European multicenter study.

Author information

1
Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
2
Department of Biomedical and NeuroMotor Sciences, University of Bologna, Viale Carlo Pepoli 5, 40123 Bologna, Italy.
3
Psy Pluriel - European Center of Psychological Medicine, Rue des Trois Arbres 62, 1180 Brussels, Belgium; School of Medicine, Free University of Brussels, Route de Lennik 808, 1070 Brussels, Belgium.
4
School of Medicine, Free University of Brussels, Route de Lennik 808, 1070 Brussels, Belgium.
5
Imperial College School of Medicine, University of London, PO Box 8751, London W13 8WH, United Kingdom.
6
Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
7
Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria. Electronic address: sci-genpsy@meduniwien.ac.at.

Abstract

This cross-sectional European multicenter study with retrospective assessment of treatment response sought to determine variables associated with the administration of augmentation strategies with second-generation antipsychotics (SGAs) and lithium in the pharmacotherapy of major depressive disorder (MDD). In 349 DSM-IV-TR MDD patients, differences in socio-demographic, clinical, treatment, and pharmacological features between participants receiving add-on treatment of their antidepressants with either SGAs (n = 318) or lithium (n = 31) were investigated using analyses of covariance, chi-squared tests, and binary logistic regression analyses. As only significant between-group difference, we found SGA augmentation (compared with lithium augmentation) to be associated with high depressive symptom severity expressed by a higher mean Montgomery and Åsberg Depression Rating (MADRS) total score (27.19 ± 11.35 vs 18.87 ± 12.88, F = 14.82, p = < .0001) and a higher mean 21-item Hamilton Rating Scale for Depression (HAM-D) total score (21.27 ± 9.30 vs 13.74 ± 9.11, F = 18.60, p = < .0001). No significant differences for socio-demographic features, psychotic symptoms, suicidality, psychiatric and somatic comorbidities, antidepressant pharmacotherapy, and other add-on medications could be seen. Even if there was no significant superiority of one augmentation strategy with regard to treatment response pattern, a trend whereupon adjunctive SGAs were more likely dispensed in treatment-resistant and difficult-to-treat MDD conditions could be observed. In terms of the prescription pattern, we could demonstrate that lithium is less frequently used than SGAs in the clinical routine care which may reflect the need of continuous plasma level determinations and the anticipation of adverse effects.

KEYWORDS:

Antidepressants; Augmentation; Lithium; Major depressive disorder; Second-generation antipsychotics

PMID:
30446357
DOI:
10.1016/j.euroneuro.2018.10.003
[Indexed for MEDLINE]

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