The Use of Atypical Antipsychotics to Augment the Effect of Antidepressants in Therapy Resistant Episodes of Recurrent Depression

Abstract

The article presents a brief overview of modern concepts of resistance in recurrent depression, as well as theoretical prerequisites for the use of atypical antipsychotics in order to augment the insufficient effect of antidepressants in this disease. The main results of clinical studies devoted to the study of the augmenting activity of individual representatives of the class of atypical antipsychotics, as well as the conclusions of a number of meta-analyses conducted on their basis, are presented. To date, the augmenting activity of quetiapine, aripiprazole, brexpiprazole and olanzapine in combination with fluoxetine can be considered the most proven. However, the data on the ratio of efficacy / tolerability of combinations of these drugs with antidepressants differ in a certain variability, which increases with the accumulation of the results of new clinical trials, which necessitates the continuation of research work. Nevertheless, despite a number of contradictions, as well as methodological shortcomings identified as a result of the analysis of available scientific data, in general, the augmentation strategy under consideration demonstrates reliable effectiveness. Currently, the addition of augmenting agents to antidepressant therapy is recommended at the third stage of antiresistance therapy within its five-stage algorithm, a direct indication for the use of atypical antipsychotics in this capacity is the presence of psychotic symptoms in the structure of the episode.