Major depressive disorder with psychosis-like symptoms in Latinos: treatment with and without antipsychotic augmentation

Abstract

To compare outcomes from two different treatment strategies in Latino patients with major depressive disorder (MDD) and psychosis-like symptoms: antidepressant medications alone versus a combination of antipsychotic and antidepressant medications, we retrospectively examined the clinical charts of 37 Latino patients with MDD and psychosis-like symptoms from one of our community affiliated clinics, admitted from January 2010 to June 2011. Outcomes included depressive response and remission based on improvement in Patient Health Questionnaire-9 scores. Psychosis-like symptoms were assessed through a specific database created for the study. To qualify for outcomes analysis, patients had to have had adequate treatment with relevant medications for at least eight weeks at therapeutic doses. In all, 24 subjects met the criteria for analysis, and 11 received an antipsychotic medication. Of the 10 subjects who received an antipsychotic, 3 (30%) achieved depressive response. Of the 14 subjects who did not receive any antipsychotic, 10 (71%) attained depressive response. However, significance for the comparison was lost when Fisher's correction was applied (p = .095). Remission rates from depression were lower in both groups, with the same distribution in favor of subjects treated without antipsychotic, although it was not significant because of the small sample size (10% versus 43%; p = .172). Remission from psychosis-like symptoms occurred in 4 of 9 (44%) and in 12 of 15 (80%) subjects treated with and without antipsychotic (p = .099). Our preliminary data suggest that patients affected by MDD with psychosis-like symptoms are likely to achieve remission from both depressive and psychosis-like symptoms even without antipsychotic augmentation of their antidepressant regimen.

Keywords:

• major depressive disorder
• psychosis-like symptoms
• antipsychotic augmentation
• Latinos
• idioms of distress

Notes on contributors

All contributors have specialized in studying major depressive disorder. Dr. Cassano and Dr. Mischoulon have a particular interest in psychosis-like symptoms in Latinos.