Persisting low use of antipsychotics in the treatment of major depressive disorder with psychotic features

Carmen Andreescu, Benoit H. Mulsant, Catherine Peasley-Miklus, Anthony J. Rothschild, Alastair J. Flint, Moonseong Heo, Melynda Caswell, Ellen M. Whyte, Barnett S. Meyers

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Objective: Practice guidelines recommend the use of a combination of an antidepressant and an antipsychotic for the pharmacologic treatment of major depressive disorder with psychotic features (MD-Psy). We assessed the extent to which the pharmacotherapy received by patients with MD-Psy under usual care conforms to these recommendations. Method: We assessed the pharmacotherapy received under usual care conditions by 100 patients with MD-Psy prior to enrollment in STOP-PD (Study of the Pharmacotherapy of Psychotic Depression), a 12-week randomized, controlled trial comparing olanzapine plus sertraline to olanzapine plus placebo. Our assessment took place from January 2003 to May 2004. The strength of antidepressant trials was rated using the Antidepressant Treatment History Form (ATHF). The strength of antipsychotic trials or combinations of antidepressants and antipsychotics was rated using a modified version of the ATHF. We also determined whether the strength of antipsychotic or combination trials was associated with age, the duration of the current depressive episode, medical burden, cognitive status, or the severity of depressive or psychotic symptoms. Results: Most patients with MD-Psy were treated with antidepressants (N = 82, 82%) or antipsychotics (N = 65, 65%). About half of the patients (N = 48, 48%) received therapeutic doses of an antidepressant; 10% (N = 10) received an intermediate dose of an antipsychotic, and 6% (N = 6) received a high dose. Overall, only 5% (N = 5) received a combination of an adequate dose of an antidepressant and a high dose of an antipsychotic. The strength of both antipsychotic trials (p = .021) and combination trials (p = .039) was significantly associated only with a longer duration of the current depressive episode. Conclusions: These findings show a persisting low use of antipsychotics in the treatment of MD-Psy. Given the high morbidity rates associated with MD-Psy, it is important to continue to educate clinicians regarding its identification and treatment. Clinical Trials Registration: ClinicalTrials.gov identifier NCT00056472.

Original languageEnglish (US)
Pages (from-to)194-200
Number of pages7
JournalJournal of Clinical Psychiatry
Volume68
Issue number2
StatePublished - Feb 2007
Externally publishedYes

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Major Depressive Disorder
Antipsychotic Agents
Antidepressive Agents
olanzapine
Therapeutics
Drug Therapy
History
Sertraline
Practice Guidelines
Randomized Controlled Trials
Placebos
Clinical Trials
Depression
Morbidity

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology

Cite this

Andreescu, C., Mulsant, B. H., Peasley-Miklus, C., Rothschild, A. J., Flint, A. J., Heo, M., ... Meyers, B. S. (2007). Persisting low use of antipsychotics in the treatment of major depressive disorder with psychotic features. Journal of Clinical Psychiatry, 68(2), 194-200.

Persisting low use of antipsychotics in the treatment of major depressive disorder with psychotic features. / Andreescu, Carmen; Mulsant, Benoit H.; Peasley-Miklus, Catherine; Rothschild, Anthony J.; Flint, Alastair J.; Heo, Moonseong; Caswell, Melynda; Whyte, Ellen M.; Meyers, Barnett S.

In: Journal of Clinical Psychiatry, Vol. 68, No. 2, 02.2007, p. 194-200.

Research output: Contribution to journalArticle

Andreescu, C, Mulsant, BH, Peasley-Miklus, C, Rothschild, AJ, Flint, AJ, Heo, M, Caswell, M, Whyte, EM & Meyers, BS 2007, 'Persisting low use of antipsychotics in the treatment of major depressive disorder with psychotic features', Journal of Clinical Psychiatry, vol. 68, no. 2, pp. 194-200.
Andreescu C, Mulsant BH, Peasley-Miklus C, Rothschild AJ, Flint AJ, Heo M et al. Persisting low use of antipsychotics in the treatment of major depressive disorder with psychotic features. Journal of Clinical Psychiatry. 2007 Feb;68(2):194-200.
Andreescu, Carmen ; Mulsant, Benoit H. ; Peasley-Miklus, Catherine ; Rothschild, Anthony J. ; Flint, Alastair J. ; Heo, Moonseong ; Caswell, Melynda ; Whyte, Ellen M. ; Meyers, Barnett S. / Persisting low use of antipsychotics in the treatment of major depressive disorder with psychotic features. In: Journal of Clinical Psychiatry. 2007 ; Vol. 68, No. 2. pp. 194-200.
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abstract = "Objective: Practice guidelines recommend the use of a combination of an antidepressant and an antipsychotic for the pharmacologic treatment of major depressive disorder with psychotic features (MD-Psy). We assessed the extent to which the pharmacotherapy received by patients with MD-Psy under usual care conforms to these recommendations. Method: We assessed the pharmacotherapy received under usual care conditions by 100 patients with MD-Psy prior to enrollment in STOP-PD (Study of the Pharmacotherapy of Psychotic Depression), a 12-week randomized, controlled trial comparing olanzapine plus sertraline to olanzapine plus placebo. Our assessment took place from January 2003 to May 2004. The strength of antidepressant trials was rated using the Antidepressant Treatment History Form (ATHF). The strength of antipsychotic trials or combinations of antidepressants and antipsychotics was rated using a modified version of the ATHF. We also determined whether the strength of antipsychotic or combination trials was associated with age, the duration of the current depressive episode, medical burden, cognitive status, or the severity of depressive or psychotic symptoms. Results: Most patients with MD-Psy were treated with antidepressants (N = 82, 82{\%}) or antipsychotics (N = 65, 65{\%}). About half of the patients (N = 48, 48{\%}) received therapeutic doses of an antidepressant; 10{\%} (N = 10) received an intermediate dose of an antipsychotic, and 6{\%} (N = 6) received a high dose. Overall, only 5{\%} (N = 5) received a combination of an adequate dose of an antidepressant and a high dose of an antipsychotic. The strength of both antipsychotic trials (p = .021) and combination trials (p = .039) was significantly associated only with a longer duration of the current depressive episode. Conclusions: These findings show a persisting low use of antipsychotics in the treatment of MD-Psy. Given the high morbidity rates associated with MD-Psy, it is important to continue to educate clinicians regarding its identification and treatment. Clinical Trials Registration: ClinicalTrials.gov identifier NCT00056472.",
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AU - Mulsant, Benoit H.

AU - Peasley-Miklus, Catherine

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AU - Flint, Alastair J.

AU - Heo, Moonseong

AU - Caswell, Melynda

AU - Whyte, Ellen M.

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N2 - Objective: Practice guidelines recommend the use of a combination of an antidepressant and an antipsychotic for the pharmacologic treatment of major depressive disorder with psychotic features (MD-Psy). We assessed the extent to which the pharmacotherapy received by patients with MD-Psy under usual care conforms to these recommendations. Method: We assessed the pharmacotherapy received under usual care conditions by 100 patients with MD-Psy prior to enrollment in STOP-PD (Study of the Pharmacotherapy of Psychotic Depression), a 12-week randomized, controlled trial comparing olanzapine plus sertraline to olanzapine plus placebo. Our assessment took place from January 2003 to May 2004. The strength of antidepressant trials was rated using the Antidepressant Treatment History Form (ATHF). The strength of antipsychotic trials or combinations of antidepressants and antipsychotics was rated using a modified version of the ATHF. We also determined whether the strength of antipsychotic or combination trials was associated with age, the duration of the current depressive episode, medical burden, cognitive status, or the severity of depressive or psychotic symptoms. Results: Most patients with MD-Psy were treated with antidepressants (N = 82, 82%) or antipsychotics (N = 65, 65%). About half of the patients (N = 48, 48%) received therapeutic doses of an antidepressant; 10% (N = 10) received an intermediate dose of an antipsychotic, and 6% (N = 6) received a high dose. Overall, only 5% (N = 5) received a combination of an adequate dose of an antidepressant and a high dose of an antipsychotic. The strength of both antipsychotic trials (p = .021) and combination trials (p = .039) was significantly associated only with a longer duration of the current depressive episode. Conclusions: These findings show a persisting low use of antipsychotics in the treatment of MD-Psy. Given the high morbidity rates associated with MD-Psy, it is important to continue to educate clinicians regarding its identification and treatment. Clinical Trials Registration: ClinicalTrials.gov identifier NCT00056472.

AB - Objective: Practice guidelines recommend the use of a combination of an antidepressant and an antipsychotic for the pharmacologic treatment of major depressive disorder with psychotic features (MD-Psy). We assessed the extent to which the pharmacotherapy received by patients with MD-Psy under usual care conforms to these recommendations. Method: We assessed the pharmacotherapy received under usual care conditions by 100 patients with MD-Psy prior to enrollment in STOP-PD (Study of the Pharmacotherapy of Psychotic Depression), a 12-week randomized, controlled trial comparing olanzapine plus sertraline to olanzapine plus placebo. Our assessment took place from January 2003 to May 2004. The strength of antidepressant trials was rated using the Antidepressant Treatment History Form (ATHF). The strength of antipsychotic trials or combinations of antidepressants and antipsychotics was rated using a modified version of the ATHF. We also determined whether the strength of antipsychotic or combination trials was associated with age, the duration of the current depressive episode, medical burden, cognitive status, or the severity of depressive or psychotic symptoms. Results: Most patients with MD-Psy were treated with antidepressants (N = 82, 82%) or antipsychotics (N = 65, 65%). About half of the patients (N = 48, 48%) received therapeutic doses of an antidepressant; 10% (N = 10) received an intermediate dose of an antipsychotic, and 6% (N = 6) received a high dose. Overall, only 5% (N = 5) received a combination of an adequate dose of an antidepressant and a high dose of an antipsychotic. The strength of both antipsychotic trials (p = .021) and combination trials (p = .039) was significantly associated only with a longer duration of the current depressive episode. Conclusions: These findings show a persisting low use of antipsychotics in the treatment of MD-Psy. Given the high morbidity rates associated with MD-Psy, it is important to continue to educate clinicians regarding its identification and treatment. Clinical Trials Registration: ClinicalTrials.gov identifier NCT00056472.

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