Pharmacotherapy for Treatment-Resistant Depression: Antidepressants and Atypical Antipsychotics

Abstract

Treatment-resistant depression (TRD) affects one in three patients with major depressive disorder and is associated with increased risk of all-cause mortality. Studies of real-world practices suggest that antidepressant monotherapy continues to be the most widely used treatment after inadequate response to a first-line treatment. However, rates of remission with antidepressants in TRD are suboptimal. Atypical antipsychotics are the most widely studied augmentation agent and aripiprazole, brexpiprazole, cariprazine, quetiapine extended-release, and olanzapine-fluoxetine combination are approved for depression. Benefits of using atypical antipsychotics for TRD has to be weighted against their potential adverse events, such as weight gain, akathisia, and tardive dyskinesia.

Keywords: Antidepressants; Aripiprazole; Atypical antipsychotics; Brexpiprazole; Cariprazine; Major depressive disorder; Quetiapine; Treatment-resistant depression.