Table 20Summary of included studies. Comparison 19. Switching to combined SSRI + antipsychotic versus switching to antipsychotic-only

StudyPopulationInterventionComparisonDetails of inadequate response/treatment resistanceComments

Corya 2006

RCT

16 countries

N=305

Mean age (years): NR

Gender (% female): NR

Ethnicity (% BME): NR

Baseline severity: NR (more severe)

Fluoxetine 25 or 50mg/day + Olanzapine 6 or 12mg/dayOlanzapine 6 or 12mg/dayTRD: Inadequate response to a SSRI after at least 6 weeks at a therapeutic dose at entry into the trial and inadequate response (<30% improvement in MADRS total score) to an open-label, 7-week lead-in phase of venlafaxine (75–375 mg/day according to the investigator’s clinical judgment)

Treatment length (weeks): 12

Outcomes:

  • Depression symptomatology change score
  • Remission
  • Response
  • Discontinuation due to any reason
  • Discontinuation due to side effects

Shelton 2005

RCT

US & Canada

N=290

Mean age (years): 43.0

Gender (% female): 66

Ethnicity (% BME): 13

Baseline severity: MADRS 28.45 (more severe)

Fluoxetine 25-50mg/day + Olanzapine 6-12mg/dayOlanzapine 6-12mg/dayTRD: History of at least 1 failure to respond to SSRI after at least 4 weeks at a therapeutic dose, and failure to respond (<30% improvement on MADRS) to nortriptyline (25-175mg/day; mean modal dose 104.6mg/day) during a 7-week open-label treatment phase

Treatment length (weeks): 8

Outcomes:

  • Depression symptomatology change score
  • Remission
  • Response
  • Discontinuation due to any reason
  • Discontinuation due to side effects

BME: black and minority ethnic; MADRS: Montgomery-Asberg depression rating scale; NR: not reported; RCT: randomised controlled trial; SSRI: selective serotonin reuptake inhibitor; TRD: treatment-resistant depression

From: Further-line treatment

Cover of Further-line treatment
Further-line treatment: Depression in adults: Evidence review D.
NICE Guideline, No. 222.
Copyright © NICE 2022.

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