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Unipolar depression in adults: Treatment with second-generation antipsychotics

Author
Craig Nelson, MD
Section Editor
Peter P Roy-Byrne, MD
Deputy Editor
David Solomon, MD

INTRODUCTION

Second-generation antipsychotics are often indicated for unipolar major depression, as well as other psychiatric disorders such as schizophrenia and bipolar disorder. For major depression, atypical antipsychotics are used adjunctively for nonpsychotic patients who respond insufficiently to antidepressant monotherapy [1,2]. Second-generation antipsychotics in combination with an antidepressant are also effective for psychotic depression [3], and the atypical antipsychotic quetiapine is effective as monotherapy for nonpsychotic depression [4]. The efficacy of atypical antipsychotics for major depression is hypothesized to be the result of their serotonergic, noradrenergic, and dopaminergic effects [5-11].

First-generation antipsychotics have also been used to treat depression, initially as monotherapy and subsequently as adjunctive treatment with an antidepressant [12,13]. Randomized trials found that for nonpsychotic depression, first-generation antipsychotic monotherapy was superior to placebo and either comparable or superior to an antidepressant. However, the use of first-generation antipsychotics for depression has declined because of the risk of tardive dyskinesia, which is greater for first-generation than second-generation antipsychotics [14].  

This topic reviews the use of second-generation antipsychotics for treating unipolar major depression. The initial treatment of depression, treatment of resistant depression, clinical features and diagnosis of depression, and the pharmacology of second-generation antipsychotics are discussed separately.

(See "Unipolar major depression in adults: Choosing initial treatment".)

(See "Unipolar depression in adults: Treatment of resistant depression".)

                            

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Literature review current through: Nov 2016. | This topic last updated: Wed Aug 03 00:00:00 GMT+00:00 2016.
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