A New Adjunctive Approach for Patients with Treatment-Refractory Depression

Augmenting antidepressants with atypical antipsychotics often works in patients with nonresponsive depression, although metabolic and other adverse effects limit utility. In a manufacturer-funded, two-stage trial, 207 patients with nonresponsive depression and taking selective serotonin reuptake inhibitors or serotonin–norepinephrine reuptake inhibitors were first randomized in a 3:1 ratio to pimavanserin (34 mg) or placebo. After 5 weeks, stage two began. Placebo nonresponders were rerandomized to pimavanserin or placebo, and pimavanserin recipients and placebo responders continued their regimens; pimavanserin and placebo groups each had 29 participants. Pimavanserin is FDA-approved for psychosis in patients with Parkinson disease.

The pool…