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Psychiatr Prax 2012; 39(02): 57-63
DOI: 10.1055/s-0031-1277013
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Augmentation von Antidepressiva mit atypischen Antipsychotika bei Nonresponse auf eine Antidepressiva-Monotherapie

Eine systematische Übersichtsarbeit randomisierter placebokontrollierter Studien bei unipolarer nicht wahnhafter DepressionAugmentation of Antidepressants with Atypical Antipsychotics in Non-Delusional Unipolar Depressed Patients with Non-Response to Antidepressant-MonotherapyA Systematic Review About Randomized Placebo Controlled Trials
Sebastian Erbe
1   Abteilung für Psychiatrie der Schlosspark-Klinik, Berlin
,
Stefan Gutwinski
2   Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Berlin
,
Tom Bschor
1   Abteilung für Psychiatrie der Schlosspark-Klinik, Berlin
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
21. Dezember 2011 (online)

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Zusammenfassung

Anliegen Untersuchung des Nutzens einer Augmentationsbehandlung mit atypischen Antipsychotika bei Depression.

Methode Literatursuche in der Pubmed-Datenbank der Jahrgänge 1990 – 2011. Kritische Beurteilung der gefundenen Studienlage.

Ergebnisse 14 RCT wurden gefunden. Untersucht wurden Olanzapin, Quetiapin, Risperidon und Aripiprazol. Es handelt sich um eine Alternative zur etablierten Lithiumaugmentation. In Deutschland ist nur retardiertes Quetiapin zugelassen.

Schlussfolgerung Die Kenntnisse der dargestellten Augmentationsstrategie ermöglichen eine bessere Behandlung der Depression.

Abstract

Objective Augmentation of antidepressants with atypical antipsychotics is used in depressive patients with non-response to antidepressants. We investigated the utility of this strategy.

Methods Systematic computer-based search in the online library Pubmed for randomized placebo-controlled double-blind trials (RCT) from the years 1990 to 2011.

Results We found 14 RCT about augmentation of antidepressants with atypical antipsychotics in depressive patients with non-response to antidepressants. Trials examined olanzapine, risperidone, quetiapine and aripiprazole.

Conclusions Augmentation of antidepressants with atypical antipsychotics is an alternative to the augmentation with lithium in unipolar depressive patients with non-response to antidepressants. But treatment with atypical antipsychotics as opposed to placebo increases the risk of non-compliance due to side-effects of medication. Augmentation of antidepressants with atypical antipsychotics in unipolar depression is an off-label therapy in Germany except for the augmentation with extended-release quetiapine. Knowledge about treatment strategies regarding augmentation of antidepressants with atypical antipsychotics can increase the chance of a successful treatment, but interactions and side-effects should be considered.

Schlüsselwörter

Augmentation - atypische Antipsychotika - therapieresistente Depression

Keywords

augmentation - atypical antipsychotics - treatment resistant depression
 

  • Literatur

  • 1 Bschor T. Definition, klinisches Bild und Epidemiologie therapieresistenter Depressionen. In: Bschor T. Behandlungsmanual therapieresistente Depression. Pharmakotherapie. Somatische Therapieverfahren. Psychotherapie. Stuttgart: Kohlhammer; 2008: 11-16
    Google Scholar
  • 2 Souery D, Lipp O, Massat I et al. The characterization and definition of treatment-resistant mood disorders. In: Amsterdam JD, Hornig M, Nierenberg AA. Treatment-resistant mood disorders. Cambridge: University Press; 2001: 3-29
    CrossrefGoogle Scholar
  • 3 Thase ME, Rush AJ. Treatment-resistant depression. In: Bloom FE, Kupfer DJ. Psychopharmacology: The fourth generation of progress. New York: Raven Press; 1995: 1081-1097
    Google Scholar
  • 4 Rush AJ. Aktueller Stand und Perspektiven der Forschung. In: Bauer M, Berghöfer A, Adli M. Akute und therapieresistente Depressionen. Berlin: Springer; 2005: 3-19
    CrossrefGoogle Scholar
  • 5 Nierenberg AA, Amsterdam JD. Treatment-resistant depression: definition and treatment approaches. J Clin Psychiatry 1990; 51: 39-47
    PubMedGoogle Scholar
  • 6 Bschor T, Bauer M. Therapieresistente Depressionen. In: Lemke RM. Affektive Störungen. Stuttgart: Thieme; 2004: 101-115
    Google Scholar
  • 7 Bschor T, Baethge C. No evidence for switching the antidepressant: systematic review and meta-analysis of RCTs of a common therapeutic strategy. Acta Psychiatr Scand 2010; 121: 174-179
    CrossrefPubMedGoogle Scholar
  • 8 Friemel S, Bernert S, Angermeyer MC et al. Die direkten Kosten von depressiven Erkrankungen in Deutschland. Ergebnisse aus dem European Study of the Epidemiology of Mental Disorders (ESEMeD) Projekt. Psychiat Prax 2005; 32: 113-121
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 9 Spießl H, Hübner-Liebermann B, Hajak G. Volkskrankheit Depression: Epidemiologie, Versorgungssituation, Diagnostik, Therapie und Prävention. Dtsch Med Wochenschr 2006; 131: 35-40
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 10 Salize HJ, Stamm K, Schubert M et al. Behandlungskosten von Patienten mit Depressionsdiagnose in haus- und fachärztlicher Versorgung in Deutschland. Psychiat Prax 2004; 31: 147-156
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 11 Unger HP. Depression und Arbeitswelt. Psychiat Prax 2007; 34 (Suppl. 03) 256-260
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 12 Bschor T, Bauer M. Efficacy and mechanisms of action of lithium augmentation in refractory major depression. Curr Pharm Des 2006; 12: 2985-2992
    CrossrefPubMedGoogle Scholar
  • 13 Bauer M, Crossley NA, Gerber S et al. The acute antidepressive effects of lithium: from monotherapy to augmentation therapy in major depression. In: Bauer M, Grof P, Müller-Oerlinghausen B. Lithium in neuropsychiatry. The comprehensive guide. London: Informa healthcare; 2006: 109-127
    CrossrefGoogle Scholar
  • 14 DGPPN, BÄK, KBV, AWMF, AkdÄ, BPtK, BApK, DAGSHG, DEGAM, DGPM, DGPs, DGRW (Hrsg) für die Leitliniengruppe Unipolare Depression*. S3-Leitlinie/Nationale Versorgungsleitlinie Unipolare Depression. 1. Auflage. Berlin, Düsseldorf: DGPPN, ÄZQ, AWMF; 2009. Internet: www.dgppn.de www.versorgungsleitlinien.de www.awmf-leitlinien.de (*Organisationen, die in der Leitliniengruppe kooperierten: DGPPN, BÄK, KBV, AWMF, AkdÄ, BPtK, BApK, DAGSHG, DEGAM, DGPM, DGPs, DGRW, BDK,BDP,BPM,BVDN, BVDP, BVVP, CPKA, DÄVT, DFT, DGGPP, DGPT, DGVT, DPG, DPV, DPtV, DVT, Deutscher Hausärzteverband, GwG, KND)
    Google Scholar
  • 15 Bauer M, Bschor T, Pfennig A et al. WFSBP Task force on unipolar depressive disorders. World Federation of Societies of Biological Psychiatry (WFSBP). Guidelines for biological treatment of unipolar depressive disorders in primary care. World J Biol Psychiatry 2007; 8: 67-104
    CrossrefPubMedGoogle Scholar
  • 16 Bschor T. Augmentationsverfahren. In: Bschor T. Behandlungsmanual therapieresistente Depression. Pharmakotherapie. Somatische Therapieverfahren. Psychotherapie. Stuttgart: Kohlhammer; 2008: 114-115
    Google Scholar
  • 17 Shelton RC, Papakostas GI. Augmentation of antidepressants with atypical antipsychotics for treatment-resistant major depressive disorder. Acta Psychiatr Scand 2008; 117: 253-259
    CrossrefPubMedGoogle Scholar
  • 18 Philip NS, Carpenter LL, Tyrka AR et al. Augmentation of antidepressants with atypical antipsychotics: a review of the current literature. J Psychiatr Pract 2008; 14: 34-44
    CrossrefPubMedGoogle Scholar
  • 19 Konstantinidis A, Papageorgiou K, Grohmann R et al. Increase of antipsychotic medication in depressive inpatients from 2000 to 2007: results from the AMSP International Pharmacovigilance Program. Int J Neuropsychopharmacol 2011; 17: 1-9
    PubMedGoogle Scholar
  • 20 Papakostas GI, Shelton RC, Smith J et al. Augmentation of antidepressants with atypical antipsychotic medications for treatment-resistant major depressive disorder: a meta-analysis. J Clin Psychiatry 2007; 68: 826-831
    CrossrefPubMedGoogle Scholar
  • 21 Nelson JC, Papakostas GI. Atypical antipsychotic augmentation in major depressive disorder: A meta-analysis of placebo-controlled randomized trials. Am J Psychiatry 2009; 166: 980-991
    CrossrefPubMedGoogle Scholar
  • 22 Calabrese JR, Keck PE, Macfadden W et al. A randomized, double-blind, placebo-controlled trial of quetiapine in the treatment of bipolar I or II depression. Am J Psychiatry 2005; 162: 1351-1360
    CrossrefPubMedGoogle Scholar
  • 23 Thase ME, Macfadden W, Weisler RH et al. BOLDER II Study Group. Efficacy of quetiapine monotherapy in bipolar I and II depression: a double-blind, placebo-controlled study (the BOLDER II study). J Clin Psychopharmacol 2006; 26: 600-609
    CrossrefPubMedGoogle Scholar
  • 24 Kirsch I, Sapirstein G. Listening to prozac but hearing placebo: a meta-analysis of antidepressant medication. Prevention & Treatment 1998; 1 Article 0002a
    PubMedGoogle Scholar
  • 25 Stolk P, Ten Berg MJ, Hemels ME et al. Meta-analysis of placebo rates in major depressive disorder trials. Ann Pharmacother 2003; 37: 1891-1899
    CrossrefPubMedGoogle Scholar
  • 26 Bauer M, Whybrow PC, Angst J et al. WFSBP Task force on treatment guidelines for unipolar depressive disorders, World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for biological treatment of unipolar depressive disorders, Part 1: Acute and continuation treatment of depressive disorders. World J Biol Psychiatr 2002; 3: 5-43
    CrossrefPubMedGoogle Scholar
  • 27 Keller MB, Lavori PW, Mueller TI et al. Time to recovery, chronicity, and levels of psychopathology in major depression. A 5-year prospective follow-up of 431 subjects. Arch Gen Psychiatry 1992; 49: 809-816
    CrossrefPubMedGoogle Scholar
  • 28 Shelton RC, Tollefson GD, Tohen M et al. A novel augmentation strategy for treating resistant majore depression. Am J Psychiatry 2001; 158: 131-134
    CrossrefPubMedGoogle Scholar
  • 29 Shelton RC, Williamson DJ, Corya SA et al. Olanzapine/fluoxetine combination for treatment-resistant depression: a controlled study of SSRI and nortriptyline resistance. J Clin Psychiatry 2005; 66: 1289-1297
    CrossrefPubMedGoogle Scholar
  • 30 Thase ME, Corya SA, Osuntokun O et al. A randomized, double-blind comparison of olanzapine/fluoxetine combination, olanzapine, and fluoxetine in treatment resistant major depressive disorder. J Clin Psychiatry 2007; 68: 224-236
    CrossrefPubMedGoogle Scholar
  • 31 Ostroff RB, Nelson J. Risperidone augmentation of selective serotonin reuptake inhibitors in major depression. J Clin Psychiatry 1999; 60: 256-259
    CrossrefPubMedGoogle Scholar
  • 32 Mahmoud RA, Pandina GJ, Turkoz I et al. Risperidone for treatment-refractory major depressive disorder. A randomized trial. Ann Intern Med 2007; 147: 593-602
    CrossrefPubMedGoogle Scholar
  • 33 Reeves H, Batra S, May RS et al. Efficacy of risperidone augmentation to antidepressants in the management of suicidality in major depressive disorder: A randomized, double-blind, placebo-controlled pilot study. J Clin Psychiatry 2008; 69: 1228-1236
    CrossrefPubMedGoogle Scholar
  • 34 Keitner GI, Garlow SJ, Ryan CE et al. A randomized, placebo-controlled trial of risperidone augmentation for patients with difficult-to-treat unipolar, non-psychotic major depression. J Psychiatr Res 2009; 43: 205-214
    CrossrefPubMedGoogle Scholar
  • 35 Mattingly G, Ilivicky H, Canale J et al. Quetiapin combination for treatment-resistant depression. Presented at the 159th annual meeting of the American Psychiatric Association, Toronto, Canada: 20−25 May, 2006
    PubMedGoogle Scholar
  • 36 Khullar A, Chokka P, Fullerton D. Quetiapine as treatment of non-psychotic unipolar depression with residual symptoms: double blind, randomized, placebo controlled study. Presented at the 159th annual meeting of the American Psychiatric Association, Toronto, Canada: 20−25 May, 2006
    PubMedGoogle Scholar
  • 37 McIntyre A, Gendron A, McIntyre A. Quetiapine adjunct to selective serotonin reuptake inhibitors or venlafaxine in patients with major depression, comorbid anxiety, and residual depressive symptoms: a randomized, placebo controlled pilot study. Depress Anxiety 2007; 24: 487-494
    CrossrefPubMedGoogle Scholar
  • 38 Bauer M, Pretorius HW, Constant EL et al. Extended-release quetiapine as adjunct to an antidepressant in patients with major depressive disorder: Results of a randomized, placebo-controlled, double-blind study. J Clin Psychiatry 2009; 70: 540-549
    CrossrefPubMedGoogle Scholar
  • 39 El-Khalili N, Joyce M, Atkinson S et al. Extended-release quetiapine fumarate (quetiapine XR) as adjunctive therapy in major depressive disorder (MDD) in patients with an inadequate response to ongoing antidepressant treatment: a multicentre, randomized, double-blind, placebo-controlled study. Int J Neuropsychopharmacol 2010; 13: 917-932
    CrossrefPubMedGoogle Scholar
  • 40 Regen F, Benkert O. Quetiapin – Zulassung als add-on zu Antidepressiva zur Augmentationsbehandlung bei Episoden einer Major Depression. Kompendium News der psychiatrischen Pharmakotherapie. Heidelberg: 10. November 2010 http://www.kompendium-news.de/2010/11/quetiapin-zulassung-als-add-on-zu-antidepressiva-zur-augmentationsbehandlung-bei-episoden-einer-major-depression/ Letzter Zugriff 20.08.2011
    PubMedGoogle Scholar
  • 41 Berman RM, Marcus RN, Swanink R et al. The efficacy and safety of aripiprazole as adjunctive therapy in major depressive disorder: A multicenter, randomized, double-blind, placebo-controlled study. J Clin Psychiatry 2007; 68: 843-853
    CrossrefPubMedGoogle Scholar
  • 42 Marcus RN, McQuade RD, Carson WH et al. The efficacy and safety of aripiprazole as adjunctive therapy in major depressive disorder: A second multicenter, randomized, double-blind, placebo-controlled study. J Clin Psychopharmacol 2008; 28: 156-165
    CrossrefPubMedGoogle Scholar
  • 43 Berman RM, Fava M, Thase ME et al. Aripiprazole augmentation in major depressive disorder: a double-blind, placebo-controlled study in patients with inadequate response to antidepressants. CNS Spectr 2009; 14: 197-206
    PubMedGoogle Scholar
  • 44 Nelson JC, Pikalov A, Berman RM. Augmentation treatment in major depressive disorder: focus on aripiprazole. Neuropsychiatr Dis Treat 2008; 4: 937-948
    PubMedGoogle Scholar
  • 45 Bschor T, Bauer M. Efficacy and mechanisms of action of lithium augmentation in refractory major depression. Curr Pharm Des 2006; 12: 2985-2992
    CrossrefPubMedGoogle Scholar
  • 46 Köberle U. Augmentation mit Schilddrüsenhormonen. In: Bschor T, Hrsg. Behandlungsmanual therapieresistente Depression. Pharmakotherapie – somatische Therapieverfahren – Psychotherapie. Stuttgart: Kohlhammer; 2008: 129-141
    Google Scholar
  • 47 Barbee JG, Conrad EJ, Jamhour NJ. The effectiveness of olanzapine, risperidone, quetiapine, and ziprasidone as augmentation agents in treatment-resistant major depressive disorder. J Clin Psychiatry 2004; 65: 975-981
    CrossrefPubMedGoogle Scholar
  • 48 Crossley NA, Bauer M. Acceleration and augmentation of antidepressants with lithium for depressive disorders: two meta-analyses of randomized, placebo-controlled trials. J Clin Psychiatry 2007; 68: 935-940
    CrossrefPubMedGoogle Scholar
  • 49 Rapaport MH, Gharabawi GM, Canuso CM et al. Effects of risperidone augmentation in patients with treatment-resistant-depression: results of open-label treatment followed by double-blind continuation. Neuropsychopharmacol 2006; 31: 2505-2513
    CrossrefPubMedGoogle Scholar
  • 50 Bschor T, Berghöfer A, Ströhle A et al. How long should the lithium augmentation strategy be maintained? A 1-Year follow-up of a placebo-controlled study in unipolar refractory major depression . J Clin Psychopharmacol 2002; 22: 427-430
    CrossrefPubMedGoogle Scholar
  • 51 Bauer M, Bschor T, Kunz D et al. Double-blind, placebo-controlled trial of the use of lithium to augment antidepressant medication in continuation treatment of unipolar major depression. Am J Psychiatry 2000; 157: 1429-1435
    CrossrefPubMedGoogle Scholar
  • 52 Völkl M, Fritze J, Höffler J et al. Depressionsbehandlung in Deutschland. Eine Analyse zur Wirtschaftlichkeit durch Remission. Gesundh ökon Qual manag 2007; 12: 35-43
    PubMedGoogle Scholar
  • 53 König HH, Luppa M, Riedel-Heller S. Die Kosten der Depression und die Wirtschaftlichkeit ihrer Behandlung. Psychiat Prax 2010; 37: 213-215
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 54 Heres S, Davis J, Maino K et al. Why olanzapine beats risperidone, risperidone beats quetiapine, and quetiapine beats olanzapine: An exploratory analysis of head-to-head comparison studies of second-generation antipsychotics. Am J Psychiatry 2006; 163: 185-194
    CrossrefPubMedGoogle Scholar
  • 55 Schott G, Pachl H, Limbach U et al. Finanzierung von Arzneimittelstudien durch pharmazeutische Unternehmen und die Folgen. Teil 1: Qualitative systematische Literaturübersicht zum Einfluss auf Studienergebnisse, -protokoll und -qualität. Dtsch Arztebl Int 2010; 107: 279-285
    Google Scholar
  • 56 Schott G, Pachl H, Limbach U et al. Finanzierung von Arzneimittelstudien durch pharmazeutische Unternehmen und die Folgen. Teil 2: Qualitative systematische Literaturübersicht zum Einfluss auf Autorenschaft, Zugang zu Studiendaten sowie auf Studienregistrierung und Publikation. Dtsch Arztebl Int 2010; 107: 295-301
    Google Scholar
  • 57 Ho BC, Andreasen NC, Ziebell S et al. Long-term antipsychotic treatment and brain volumes: a longitudinal study of first-episode schizophrenia. Arch Gen Psychiatry 2011; 68: 128-137
    Google Scholar
  • 58 Dorée JP, Des Rosiers J, Lew V et al. Quetiapin augmentation of treatment-resistant depression: a comparisation with lithium. Curr Med Res Opin 2007; 23: 333-341
    CrossrefPubMedGoogle Scholar