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Depression fails to remit in many patients, even with successive treatments. The use of atypical antipsychotics to augment antidepressants when a patient’s depression fails to respond or remit has been examined multiple times. Many large studies have had negative results, although pooled studies and meta-analyses, which include smaller positive studies, show clear-cut benefits. This large, adequately powered, multisite, manufacturer-sponsored study only partially resolves the issues.
To verify lack of antidepressant response, 463 patients continued their standard antidepressants for 4 weeks (no monoamine inhibitors or tricyclic antidepressants; 59% of patients took SSRIs). Of these, 274 patients responded suboptimally and were randomized to …