There were some beneficial effects compared to placebo or antidepressants but tolerability was worse .
Quetiapine was more effective than placebo treatment .
Aripiprazole and quetiapine and partly also olanzapine and risperidone augmentation showed beneficial effects compared to placebo .
Some evidence indicated beneficial effects of low-dose amisulpride for dysthymic people .
Most SGAs showed worse tolerability
BACKGROUND Major depressive disorder ( MDD ) is a common condition with a lifetime prevalence of 15 % to 18 % , which leads to considerable suffering and disability .
Some antipsychotics have been reported to induce remission in major depression , when added to an antidepressant .
OBJECTIVES To evaluate the effects of second-generation antipsychotic ( SGA ) drugs ( alone or augmentation ) compared with placebo or antidepressants for people with MDD or dysthymia .
Efficacy of risperidone augmentation to antidepressants in the management of suicidality in major depressive disorder: a randomized, double-blind, placebo-controlled pilot study.
OBJECTIVE Major depressive disorder ( MDD ) is a severe mental illness with high risk of suicidality . Antidepressant treatment alone is not sufficient for the acute management of risk-taking symptoms of depression . This pilot study was design ed to investigate the efficacy of risperidone augmentation to antidepressants in the acute management of suicidality and other core symptoms in MDD with suicidality . METHOD Twenty-four adult men and women diagnosed with MDD ( DSM-IV ) , having a depressive episode with suicidality despite taking an antidepressant , were enrolled in an 8-week double-blind , placebo-controlled study . Subjects were r and omly assigned to receive risperidone ( 0.25 - 2 mg/day ) or placebo while continuing on their antidepressant therapy .  Clinical efficacy in suicidality , depressive symptoms , and impulsivity were assessed after treatment with study drugs for 4 days , weekly for 4 weeks , then every other week for 4 weeks . Adverse events were also recorded at each visit . The study was conducted from June 2004 to April 2007 . RESULTS Risperidone significantly reduced suicidal ideations in MDD patients , and the overall effect of risperidone appeared to be superior to placebo . The effect of risperidone was rapid , with onset at 2 weeks ' treatment , and was sustained along the course of 8 weeks ' treatment . Furthermore , risperidone demonstrated superiority to placebo in improving other symptoms related to suicidality and having better trial completion rate , and the low dose risperidone was well tolerated by subjects in this study . CONCLUSION Data from this pilot study suggest that risperidone is beneficial as an augmenting treatment in MDD patients who have developed high-risk suicidal ideation during a depressive episode . The antisuicidality effect of risperidone is especially valuable in the acute management of severe depressive symptoms . Although the pilot study is limited by small sample size , the promising results warrant further larger scale investigation in the efficacy of atypical antipsychotics in the treatment of severe depression with suicidality . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00167154
There were some beneficial effects compared to placebo or antidepressants but tolerability was worse .
Quetiapine was more effective than placebo treatment .
Aripiprazole and quetiapine and partly also olanzapine and risperidone augmentation showed beneficial effects compared to placebo .
Some evidence indicated beneficial effects of low-dose amisulpride for dysthymic people .
Most SGAs showed worse tolerability
BACKGROUND Major depressive disorder ( MDD ) is a common condition with a lifetime prevalence of 15 % to 18 % , which leads to considerable suffering and disability .
Some antipsychotics have been reported to induce remission in major depression , when added to an antidepressant .
OBJECTIVES To evaluate the effects of second-generation antipsychotic ( SGA ) drugs ( alone or augmentation ) compared with placebo or antidepressants for people with MDD or dysthymia .