Can Atypical Antipsychotic Augmentation Reduce Subsequent Treatment Failure More Effectively Among Depressed XXXX with a Higher Degree of Treatment Resistance? A Meta-Analysis of Randomized Controlled Trials.

@entity1 @entity13217 @entity308
BACKGROUND: Atypical antipsychotic augmentation was demonstrated to be efficacious in @entity13217 ( @entity13217 ) in previous meta-analyses. We investigate whether there are differences in the effect size of atypical antipsychotic augmentation in @entity308 according to the degree of treatment resistance. METHODS: A comprehensive search of four databases identified 11 randomized controlled trials. The 11 trials, which included 3 341 @entity1 , were pooled using a random-effects meta-analysis. RESULTS: Atypical antipsychotic augmentation of antidepressant therapy showed superior efficacy compared to antidepressant monotherapy in @entity13217 in terms of both response and remission rates (response, risk ratio [RR] = 1.38, 95% confidence interval [CI] = 1.25 to 1.53; remission, RR = 1.62, 95% CI = 1.42 to 1.85). In addition, regarding response rates in the @entity13217 trials, atypical antipsychotic augmentation exhibited significantly different effect sizes according to the degree of treatment resistance ( @entity13217 1: RR = 1.24; @entity13217 2: RR = 1.37; @entity13217 2-4: RR = 1.58). In non- @entity13217 trials, atypical antipsychotic augmentation failed to show superior efficacy over antidepressant monotherapy in terms of remission rates (RR = 0.89; 95% CI = 0.69 to 1.14). Atypical antipsychotic augmentation of antidepressant therapy exhibits greater effect size in @entity1 with a higher degree of treatment resistance. CONCLUSIONS: This finding strengthens the rationale for considering atypical antipsychotic augmentation among @entity308 @entity1 with multiple previous treatment failures in clinical practice. The efficacy of atypical antipsychotic augmentation for non- @entity13217 seems to be different from that for @entity13217 and, thus, further studies of non- @entity13217 populations are needed.
