Delhi: Continuing with sertraline plus olanzapine reduced the risk of relapse in patients with psychotic depression in remission as compared to treatment with sertraline plus placebo, according to a recent study in the JAMA journal.
Psychotic depression is a severely disabling and potentially lethal disorder.
“Psychotic symptoms in major depressive disorder (MDD) such as delusions of guilt or prosecution has attracted little interest in research until the observation that psychotic depression patients respond poorly to tricyclic antidepressants. Subsequent studies have shown depressive symptoms in this condition to be more severe than in MDD without psychotic features. This makes psychotic depression a severely disabling and potentially lethal disorder,” William H. Coryell, Department of Psychiatry, University of Iowa, Iowa City, wrote in an accompanying editorial.
Given the severity of the condition, it becomes important to treat the condition and prevent relapse in patients in remission. But not much research has been done on the efficacy and tolerability of continuing antipsychotic mediation for patients with psychotic depression in remission.
Alastair J. Flint, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and colleagues determined the clinical effects of continuing antipsychotic medication once an episode of psychotic depression has responded to combination treatment with an antidepressant and antipsychotic agent in this randomized controlled trial.
The trial, conducted at 4 academic medical centers over a period of thirty-six weeks from November 2011 to June 2017, consisted of 125 participants (median age 55 years). Patients aged 18 years or older had an episode of psychotic depression acutely treated with sertraline plus olanzapine for up to 12 weeks and met criteria for remission of psychosis and remission or near-remission of depressive symptoms for 8 weeks before entering the clinical trial.
Participants were randomized either to continue olanzapine (n = 64) or switch from olanzapine to placebo (n = 62). All participants continued sertraline.
The primary outcome was risk of relapse. Main secondary outcomes were change in weight, waist circumference, lipids, serum glucose, and hemoglobin A1c (HbA1c). At the time of randomization, the median dosage of sertraline was 150 mg/d (interquartile range [IQR], 150-200 mg/d) and the median dosage of olanzapine was 15 mg/d (IQR, 10-20 mg/d).
Key findings include
- Thirteen participants (20.3%) randomized to olanzapine and 34 (54.8%) to placebo experienced a relapse.
- The effect of olanzapine on the daily rate of anthropometric and metabolic measures significantly differed from placebo for weight (0.13 lb), waist circumference (0.009 inches), and total cholesterol (0.29 mg/dL) but was not significantly different for low-density lipoprotein cholesterol (0.04 mg/dL), high-density lipoprotein cholesterol (−0.01 mg/dL), triglyceride (−0.153 mg/dL), glucose (−0.02 mg/dL), or HbA1c levels (−0.0002 mg/dL).
“Among patients with psychotic depression in remission, continuing sertraline plus olanzapine compared with sertraline plus placebo reduced the risk of relapse over 36 weeks. This benefit needs to be balanced against potential adverse effects of olanzapine, including weight gain,” concluded the authors.
The bottom line of the study is — For patients with psychotic depression in remission, continuing olanzapine reduced the 36-week risk of relapse.
To read the complete study log on to