The Role of Atypical Antipsychotics in Depression in Primary Care

Depression is an increasingly prevalent presentation in primary care practice. The use of psychiatric rating scales in primary care can help monitor the severity and course of illness, including the emergence of treatment effects. Unfortunately, treatment effects frequently fall short of optimal patient response. Treatment resistance, in particular, poses an obstacle to the goal of symptom remission and a return to premorbid levels of functioning. Once treatment resistance is established, the clinician must consider increasing the dose of antidepressant, switching to another drug, or augmenting with a second drug as appropriate. There are many augmentation options, some of them limited by cumulative side effects or the potential for drug-drug interactions. Recently, some atypical antipsychotics have proved efficacious, with few side effects, as augmentation therapy for treatment-resistant major depression with and without psychotic features. The serotonergic and noradrenergic properties of these drugs may ameliorate common side effects of selective serotonin reuptake inhibitors as well as the symptoms of anxiety disorders so often comorbid with major depression.