Antidepressant and antipsychotic treatment of Psychotic Major Depression in a British mental healthcare setting

Abstract

Background

Evidence from treatment trials shows that the most effective pharmacological treatment for Psychotic Major Depression (PMD) is combined antidepressant and antipsychotic pharmacotherapy.

Aim

This study investigates the use of antidepressant and antipsychotic treatment for PMD in clinical practice and examines how treatment profiles correlate with demographic and clinical symptoms.

Method

Anonymised electronic health records of 2,837 individuals with PMD were followed up for 12-months post-diagnosis in a historic open cohort design. The use of antidepressants and antipsychotics, alone or in combination, were described using frequency statistics. Demographic and clinical characteristics associated with each treatment were assessed using logistic regression analyses.

Results

Antidepressant and antipsychotic combination pharmacotherapy was the most used treatment for PMD with 69.9% users, compared to antidepressant monotherapy (10.9%) and antipsychotic monotherapy (10.3%). The remaining 8.9% of individuals did not receive antidepressant or antipsychotic treatment. The presence of delusions was strongly associated with the use of antipsychotics, both alone (odds ratio =3.99, 95% confidence intervals = 2.72–5.83, p<.001) and in combination with antidepressants (OR = 2.7, 95% CI = 2.09–3.67, p<.001), rather than antidepressant treatment alone.

Conclusions

Combined antidepressant and antipsychotic pharmacotherapy is the most common treatment of PMD in clinical practice, showing that clinical practice is in line with evidence from treatment research.

Keywords:

• Antidepressives
• antipsychotics
• psychopharmacology
• affective disorders
• psychoses

Acknowledgements

This project received no specific grant from any funding agency, commercial or not-for-profit sectors. Megan Pritchard, Hitesh Shetty, Robert Stewart and Allan H. Young are funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Disclosure statement

Allan Young declares paid lectures and participation in advisory boards for the following companies: AstraZeneca, Eli Lilly, Janssen, Lundeck, Sunovion, Servier, Livanova, and investigator-initiated studies from AstraZeneca, Eli Lilly, Lundbeck, Wyeth. Robert Stewart declares funding and support in the last 5 years from Roche, Janssen and GSK. All other authors report no conflict of interest.

Data availability statement

The data used in this paper was from the South London and Maudsley (SLaM) Biomedical Research Centre (BRC) case register. Due to privacy protection of health-related data, access is only possible within the BRC premises.