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Tijdschrift voor Psychiatrie 50 (2008) 4, 213 - 222

Review article

Augmentation with atypical antipsychotics in the treatment of patients with a therapyresistant depression: a review

M.A. Selis, F.P.M.L. Peeters

A considerable number of depressed patients are showing resistance to current drug treatment strategies. In such cases it is becoming increasingly common in clinical practice to augment an antidepressant with an atypical antipsychotic (aap).
purpose To provide an overview of the scientific evidence for this new strategy, to explain the possible mechanisms of action and to assess the place that augmentation with an aap occupies in the treatment of therapy-resistant non-psychotic depression.
method Various search terms were used to locate relevant articles in Pubmed; these articles were examined for relevant references.
results Only 6 randomised controlled trials were found, therefore 7 case reports and 10 open-label studies were included. There seems to be some evidence that augmentation with an aap, particularly olanzapine, is effective. One of the main advantages of this strategy is the fast response, namely within a few weeks or even within a week. In view of the lack of scientific support for augmentation with aaps, this strategy is advisable when other augmentation strategies have proved unworkable or are contraindicated. It must be exercised with caution because the combination therapy can have negative effects on the patient's glucose and lipid metabolism.
conclusion Augmentation with aaps in treatment resistant depression may be a potential useful treatment strategy but its scientific evidence is insufficient to warrant inclusion within current guidelines.

keywords major depression, therapy-resistance, augmentation, atypical antipsychotics