Risk for Death when Augmenting Antidepressants with Antipsychotics

For depressed patients who do not respond to initial antidepressant regimens, clinicians increasingly opt to augment with atypical antipsychotics rather than to switch to or add another antidepressant. To assess the consequences of these choices, investigators used data from Medicaid claims and the National Death Index from 2001 to 2010.

The analysis compared mortality in 39,582 non-elderly depressed adults (mean age, 44; 78% women; 69% non-Hispanic white) whose initial antidepressant treatment for 3 months was augmented with either an atypical antipsychotic (57%) or a second antidepressant (43%). Patients with schizophrenia, psychotic depression, or bipolar disorder were excluded. Common comorbidities included anxiety (25%), hypertension (2…