When evaluating the efficacy and tolerability of additives used to supplement standard treatment for acute depressive episodes, lithium appears to be somewhat superior to second-generation antipsychotics (SGAs) and intranasal esketamines, according to the results of a systematic review and meta-analysis recently in Journal of Psychopharmacology published.
In order to clarify the efficacy and tolerability of additional treatment options in major depression, the study authors received data from randomized, placebo-controlled studies to calculate the odds ratio (OR) vs. placebo, the numbers-needed-to-treat (NNT) and the numbers needed -to-harm (NNH) when adding SGAs, esketamine, and lithium to antidepressant therapy. The analysis included a total of 49 drug-placebo pairs.
“The random effects meta-analysis of studies on the addition of SGAs versus placebo to antidepressants revealed a highly significant superiority of the SGAs overall (OR 1.59; 95% CI 1.44-1.75; z = 9.16, P < 0.0001) ”, the study authors reported. The results also showed that the effectiveness of lithium was highest among the drugs evaluated (OR 2.22; 95% CI 1.44-3.43; P = 0.0003) and that the effectiveness of esketamine was between SGAs and lithium was (OR 1.94; 95% CI 1.52-2.46; P <0.0001).
Continue reading
Based on the results for evaluating NNT, lithium was found to be the most effective add-on therapy compared to placebo (NNT, 5; 95% CI, 4–10), followed by esketamine (NNT, 7; 95% CI, 5–10) ). and overall SGAs (NNT, 11; 95% CI, 9-15). With regard to individual SGAs, aripiprazole, olanzapine plus fluoxetine, risperidone and ziprasidone with NNT values below 10 were shown to be more effective than quetiapine (NNT, 13), brexpiprazole (NNT, 16) and cariprazine (NNT, 16.). ).
Lithium turned out to be the best tolerated add-on therapy (NNH, 9; 95% CI, 5-106), followed by intranasal esketamine (NNH, 5; 95% CI, 4-6) and all pooled SGAs (NNH, 5; 95 % CI, 4-6). In the individual assessment of the SGAs, quetiapine showed the highest NNH (3) and brexpiprazole the lowest (19). The likelihood of help or harm (LLH), also known as the risk-benefit ratio (NNH / NNT), was also more favorable for lithium (LHH 1.80; 95% CI 1.25-10.60) compared to esketamine (LHH, 0.71; 95% CI, 0.60-0.80) and all SGAs pooled (LHH, 0.45; 95% CI, 0.17-0.77).
The authors found that most studies with lithium added to therapy included older antidepressants.
“Based on meta-analyzes to determine OR and NNT, several modern drugs developed as antipsychotics as well as intranasal esketamine were effective as an adjunct to antidepressants in acute depressive episodes, but lithium was slightly more effective and better tolerated,” they concluded. “The results encourage the clinical view of lithium as a particularly attractive tool in the treatment of major depression.”
reference
Vázquez GH, Bahji A, Undurraga J, Tondo L, Baldessarini RJ. Effectiveness and tolerability of combination treatments in major depression: antidepressants plus antipsychotics of the second generation vs. esketamine vs. lithium. Journal of Psychopharmacology. Published online July 9, 2021. doi: 10.1177 / 02698811211013579.
This article originally appeared on MPR
