Antipsychotics for depression in older people

Untreated or partially-treated depression in older people is associated with higher mortality due to illness and suicide. Failure of the depression to improve with antidepressant treatment is a common problem, since only 40-50% of patients respond to the first medication they are given. Recently the Sequenced Treatment Alternatives to Relieve Depression (STAR-D) study provided important information about treating patients whose depression did not improve with antidepressants but this did not cover patients over 60. Atypical antipsychotics, in combination with anti-depressants, have been increasingly studied for partially or non-responsive patients with depression and a New York trial of the drug aripiprazole, on older patients, has found that six weeks taking the drug, in conjunction with anti-depressants, led to a 50% remission rate of depression. However, the drug did have side effects including a dry mouth, which affected 25% of the participants, agitation/anxiety (20%) and drowsiness (15%). A quarter of the participants dropped out of the trial before it finished.

Rutherford, Bret ... [et al] - An open trial of aripiprazole augmentation for SSRI non-remitters with late-life depression International Journal of Geriatric Psychiatry October 2007 22(10), 986-991