{"id":34238,"date":"2013-03-15T13:56:10","date_gmt":"2013-03-15T17:56:10","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=34238"},"modified":"2013-03-15T14:30:50","modified_gmt":"2013-03-15T18:30:50","slug":"the-usual-suspects","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2013\/03\/15\/the-usual-suspects\/","title":{"rendered":"the usual suspects…"},"content":{"rendered":"\n

Treatment Resistant Depression [TRD] is a fictitious entity created by the KOL set to explain why the SSRIs weren’t wonder drugs. One of the most lucrative outcomes from TRD’s invention was the notion that adding atypical antipsychiotics would bring relief to the afflicted through some as yet unspecified mechanism. Spielmans et al<\/a> poked a hole in that fantasy with their meta-analysis [and…<\/a>] which showed statistical but little clinical efficacy for atypical antipsychiotic augmentation. In the middle of last night, the flying squirrels that have taken up residence in our in-need-of-repair roof system had their first [and hopefully last] annual nocturnal chariot races [while we await the roofers]. So I passed the time downstairs looking at the abstracts from the articles analyzed by Spielmans et al, and decided that what these authors said in the conclusions might be of general interest [I added the findings from Spielmans et al<\/a> as a reminder]. <\/p>\n

These are all industry funded clinical trials published in peer-reviwed journals. I still have to pinch myself to accept that my colleagues wrote [or at least signed on to] all of these rah rah<\/em> articles with such lackluster findings.  In the comments, Dr. Carroll listed some of the KOLs who popularized atypical antipsychiotic augmentation [here<\/a>], and I’ve added the links to the articles he mentioned to that comment that aren’t already listed below. This was a concerted campaign with all of the usual suspects<\/em> participating in concert with their industry patrons. As you read through their conclusions, recall that this is the kind of rhetoric that practitioners had available to them. This is the kind of information peddled at medical meetings. This is what we heard at required C.M.E. presentations. <\/p>\n\n\n\n\n\n
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Apiprazole [Abilify]<\/font><\/strong><\/p>\n

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Aripiprazole augmentation in major depressive disorder: a double-blind, placebo-controlled study in patients with inadequate response to antidepressants.<\/a>
by Berman RM, Fava M, Thase ME, Trivedi MH, Swanink R, McQuade RD, Carson WH, Adson D, Taylor L, Hazel J, and Marcus RN.
CNS Spectrums. 2009 14[4]:197-206.<\/strong><\/sup><\/div>\n
…As reported, adjunctive aripiprazole was associated with a two-fold higher remission rate than adjunctive placebo. This, and previous studies, have shown that discontinuations due to adverse events were low and completion rates were high, and has indicated that both antidepressant and aripiprazole in combination were relatively well-tolerated and safe. This is the third consecutive clinical trial, in the absence of a failed trial, to demonstrate that aripiprazole augmentation to antidepressants is an efficacious and well-tolerated treatment for patients with MDD who do not respond adequately to standard antidepressant monotherapy.<\/strong><\/sup><\/div>\n<\/td>\n<\/tr>\n<\/table>\n

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Olanzapine + Fluoxetine [Zyprexa + Prozac]<\/font><\/strong><\/p>\n

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Olanzapine\/fluoxetine combination for treatment-resistant depression: a controlled study of SSRI and nortriptyline resistance.<\/a>
by Shelton RC, Williamson DJ, Corya SA, Sanger TM, Van Campen LE, Case M, Briggs SD, and Tollefson GD.
Journal of Clininical Psychiatry. 2005 66(10):1289-97.<\/strong><\/sup><\/div>\n
…This 8-week, double-blind, multicenter study was undertaken to replicate, in a larger sample of patients with treatment-resistant major depressive disorder (MDD; DSM-IV criteria), the results of a pilot study of the olanzapine\/fluoxetine combination.
…The olanzapine\/fluoxetine combination did not differ significantly from the other therapies at endpoint, although it demonstrated a more rapid response that was sustained until the end of treatment. The results raised several methodological questions, and recommendations are made regarding the criteria for study entry and randomization.<\/strong><\/sup><\/div>\n<\/td>\n<\/tr>\n
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A randomized, double-blind comparison of olanzapine\/fluoxetine combination, olanzapine, fluoxetine, and venlafaxine in treatment-resistant depression.<\/a>
by Corya SA, Williamson D, Sanger TM, Briggs SD, Case M, and Tollefson G.
Depression and Anxiety. 2006 23(6):364-72.<\/strong><\/sup><\/div>\n
…Analysis of a subgroup of subjects who had an SSRI failure in their current depressive episode (n=334) revealed statistical separation from both olanzapine and fluoxetine (but not venlafaxine) at end point: OFC (-14.6) versus olanzapine (-9.4, P<.001) versus fluoxetine (-10.7, P=.006) versus venlafaxine (-14.7, P=.98). The OFC had a safety profile comparable to its component monotherapies (i.e., olanzapine and fluoxetine), showed a rapid onset of antidepressant effect, and was effective in this TRD sample. At the study end point, OFC, fluoxetine, venlafaxine, and low-dose OFC all appeared to be similarly effective.<\/strong><\/sup><\/div>\n<\/td>\n<\/tr>\n
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A randomized, double-blind comparison of olanzapine\/fluoxetine combination, olanzapine, fluoxetine in treatment-resistant major depressive disorder.<\/a>
by Thase ME, Corya SA, Osuntokun O, Case M, Henley DB, Sanger TM, Watson SB, and Dub\u00e9 S.
Journal of Clinical Psychiatry. 2007 68[2]:224-36.<\/strong><\/sup><\/div>\n
…Patients with TRD [defined as treatment failure on 2 antidepressants] taking olanzapine\/fluoxetine combination demonstrated significantly greater improvement in depressive symptoms than patients taking olanzapine or fluoxetine in 1 of 2 studies and in the pooled analysis. When considered within the context of all available evidence, olanzapine\/fluoxetine combination> is an efficacious therapy for patients with TRD.<\/strong><\/sup><\/div>\n<\/td>\n<\/tr>\n<\/table>\n

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Quetiapine [Seroquel]<\/font><\/strong><\/p>\n

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Extended-release quetiapine fumarate [quetiapine XR] as adjunctive therapy in major depressive disorder [MDD] in patients with an inadequate response to ongoing antidepressant treatment: a multicentre, randomized, double-blind, placebo-controlled study.<\/a>
by El-Khalili N, Joyce M, Atkinson S, Buynak RJ, Datto C, Lindgren P, and Eriksson H.
International Journal of Neuropsychopharmacology. 2010 13[7]:917-32.<\/strong><\/sup><\/div>\n
…In this study, quetiapine XR 300 mg\/d as adjunctive therapy in patients with MDD with an inadequate response to ongoing antidepressant treatment was effective at week 6. However, the difference from placebo for quetiapine XR 150 mg\/d at week 6 was not statistically significant. Both doses studied [150 and 300 mg\/d] were effective at week 1 and generally well tolerated.<\/strong><\/sup><\/div>\n<\/td>\n<\/tr>\n<\/table>\n

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Risperidone [Risperdal]<\/font><\/strong><\/p>\n

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Efficacy of risperidone augmentation to antidepressants in the management of suicidality in major depressive disorder: a randomized, double-blind, placebo-controlled pilot study.<\/a>
by Reeves H, Batra S, May RS, Zhang R, Dahl DC, and Li X.
Journal of Clinical Psychiatry. 2008 69[8]:1228-336.<\/strong><\/sup><\/div>\n
…Data from this pilot study suggest that risperidone is beneficial as an augmenting treatment in MDD patients who have developed high-risk suicidal ideation during a depressive episode. The antisuicidality effect of risperidone is especially valuable in the acute management of severe depressive symptoms. Although the pilot study is limited by small sample size, the promising results warrant further larger scale investigation in the efficacy of atypical antipsychotics in the treatment of severe depression with suicidality.<\/strong><\/sup><\/div>\n<\/td>\n<\/tr>\n
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A randomized, placebo-controlled trial of risperidone augmentation for patients with difficult-to-treat unipolar, non-psychotic major depression.<\/a>
by Keitner GI, Garlow SJ, Ryan CE, Ninan PT, Solomon DA, Nemeroff CB, and Keller MB.
Journal of Psychiatric Research. 2009 43(3):205-14.<\/strong><\/sup><\/div>\n
…Augmentation of an antidepressant with risperidone for patients with difficult-to-treat depression leads to more rapid response and a higher remission rate and better quality-of-life.<\/strong><\/sup><\/div>\n<\/td>\n<\/tr>\n<\/table>\n","protected":false},"excerpt":{"rendered":"

Treatment Resistant Depression [TRD] is a fictitious entity created by the KOL set to explain why the SSRIs weren’t wonder drugs. One of the most lucrative outcomes from TRD’s invention was the notion that adding atypical antipsychiotics would bring relief to the afflicted through some as yet unspecified mechanism. Spielmans et al poked a hole […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-34238","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/34238","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=34238"}],"version-history":[{"count":44,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/34238\/revisions"}],"predecessor-version":[{"id":43929,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/34238\/revisions\/43929"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=34238"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=34238"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=34238"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}