Consumer Reports: Antipsychotic "add-ons" not worth it for depression

[Altostrata]

Despite all the TV ads pushing Abilify, Consumer Reports finds antipsychotic "add-ons" to antidepressants not worth the side effects and cost in terms of efficacy.

 

The "add-on" medications reviewed: aripiprazole (Abilify), asenapine (Saphris), clozapine (Clozaril and generics), iloperidone (Fanapt), olanzapine (Zyprexa), paliperidone (Invega), quetiapine (Seroquel, Seroquel XR), risperidone (Risperdal and generics), and ziprasidone (Geodon).

 

Ironically, rather than a medical authority, it takes a consumer publication to point this out.

 

http://www.consumerreports.org/health/best-buy-drugs/antipsychotics-for-depression.htm

 

However, the available evidence indicates that antipsychotics aren't very effective at treating "resistant" depression and aren't the best choice for this use for most people. Other options, such as increasing the dose of your antidepressant or switching to a different one, are at least as effective and are safer. Combining two antidepressants may also be an option. And it remains unclear whether antipsychotics are any better than a placebo at preventing a relapse or return of depression over the long-term. Antipsychotics can also cause serious side effects, such as involuntary movements of the tongue, lips, face, trunk, arms, or legs (tardive dyskinesia), significant weight gain, and an increased risk of type 2 diabetes, heart disease, and stroke. In addition, they are very expensive, with some costing more than $1,000 a month.

 

For those reasons, the atypical antipsychotics aren't good first choices as add-ons to antidepressants, especially if you are overweight or have heart disease or diabetes. Our medical consultants recommend they be used cautiously and only after first trying the strategies listed above. In this report, we do not choose any as Best Buy selections. Instead, we evaluate how well the medications actually work at relieving resistant depression and the risk of side effects.

We'd like to point out that tapering off the antidepressant and pursuing non-drug treatments for your mood issues is an option as well.

[Rhiannon]

Or adding non-drug treatments to the antidepressant at the very least. When they say "treatment-resistant" they mean "the ADs aren't working, which they don't in the majority of cases" not that they've actually attempted reasonable treatment--such as, say, psychotherapy, and exercise, and emotional support, and sunlight therapy, and other lifestyle changes.

 

I remember way back in the Dark Ages when ADs were only considered for people for whom therapy didn't work. Nowadays I never hear of people being offered therapy as a first-line treatment for depression. It's always "you feeling a little stressed? Pop this pill. It will help." (Because physicians seem to be the LAST ones getting the news that antidepressants have not been proven to be effective except perhaps in cases of severe depression.)

 

I have a friend with end-stage colon cancer who has been put on an antidepressant. Because obviously his emotional state is due to a chemical imbalance. No offer of supportive therapy, someone to talk to about his feelings about dying.

 

Feelings are clearly a pathological condition. Human beings aren't meant to FEEL things. That might lead to, oh, I don't know, sanity, or something.

[Altostrata]

Yeah. Irony is, docs don't consider non-drug therapies until they've bounced a zillion drugs off a person's brain and concluded it's "treatment resistant."

[Barbarannamated]

Yeah. Irony is, docs don't consider non-drug therapies until they've bounced a zillion drugs off a person's brain and concluded it's "treatment resistant."

 

At which point the entire body-brain likely IS "treatment-resistant" and "chemically imbalanced". And who will treat the physical and emotional trainwreck caused by psychiatry?