Use of Atypical Antipsychotics in Refractory Depression and Anxiety

Treatment options for bipolar depression and treatment-resistant unipolar depression include augmentationof antidepressant therapy with a nonantidepressant drug, including atypical antipsychotics.Risperidone is effective in combination with fluvoxamine, paroxetine, or citalopram in treatment-resistantunipolar depression, with reported remission rates of 61% to 76%. Olanzapine in combinationwith fluoxetine is safe and effective in patients with bipolar depression and those withfluoxetine-resistant unipolar depression. Ziprasidone and aripiprazole augmentation of various selectiveserotonin reuptake inhibitors has been reported to be effective in refractory unipolar depression inopen-label studies. Data on use of quetiapine or clozapine as augmentation therapy for depression oranxiety are not yet available. Further double-blind, placebo-controlled studies of augmentation ofantidepressants with atypical antipsychotics in refractory depression and anxiety are justified basedon the available literature.