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Antipsychotics were developed for the treatment of schizophrenia, the newer ones, the second Generation Antipsychotics (SGAs), are always more often used to treat depressive symptoms particularly when they have not been improved by using antidepressants or other treatments. Depression is a common health problem but many patients 60-70%; don’t get adequate treatment because of antidepressants is ineffective for up to 40% of cases. Several atypical Antipsychotics are currently proposed and used in monotherapy or augmentation therapy and add-ons, to treat Major Depression (MD), particularly in the case of “resistant depression”. They are aripiprazole, quetipine, amisulpride, olanzapine, ziprasidone, asenapine, iloperidone, lurasidone, paliperidone, risperidone, brexpiprazole and clozapine. Three, aripiprazole, quetipine, olanzapine and a combination tablet olanzapine plus the antidepressant fluoxetine are approved by the Food and Drug administration for this use, but the other Antipsychotics are often used “off-label”. However, several Authors indicate that Antipsychotics are not as effective as augmentation therapy for treating “resistant MD” and are not the best choice for most depressed patients. Other options such as increasing the dose of the antidepressant or switching to different ones are at least both effective and safer. Antipsychotics can also cause serious side effects such as involuntary movements, over weight gain, and an increased risk of type 2 diabetes, heart disease, and stroke. In addition they are very expensive [3]. For those reasons, in our opinion, the atypical Antipsychotics could not be considered good first choices as antidepressant or as add-ons to antidepressant especially in the case of overweight, heart disease or diabetes especially In any case there are persuasive evidences for the antidepressant efficiency   of some SGAs in clinical trials, as well as for the increase of their prescription in the treatment of patients with MD. Moreover, the use of SGAs in MDD is anticipated to grow and continue to be one of the leading augmentation strategies.

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Nancy Ella
Journal Editor
Dual Diagnosis: Open Access
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