How Effective Are Antipsychotics for Depression?

Antipsychotics for depression can be effective for some patients with treatment-resistant symptoms that don’t resolve on antidepressant medication alone. The new generation of drugs, atypical antipsychotics, are most suitable, but have not been formally approved for this use. This means that patients need to use them in an off-label setting, without the benefit of lengthy clinical trials to document their efficacy and determine appropriate dosing.

Patients with depression may need to try several antidepressant medications, each of which can take several weeks to start working. If the patient still doesn’t respond to treatment, a medical provider may consider augmenting with another drug to see if it helps. Antipsychotics for depression appear to work well in this setting for some patients, as they act on some of the biochemical pathways in the brain that can be involved in depressive episodes. The patient’s depressed mood may lift and stabilize with several weeks of treatment.

These medications can be used as a secondary therapy, but not alone for the treatment of depression. Research on using antipsychotics for depression also suggests that they should be used in the short term only. Once the patient is stable, it may be possible to transition off the medication and maintain that stability on a long-term antidepressant. If the patient’s psychiatric disturbances return, the antipsychotic therapy can be resumed to address the issue.

There are some concerns about using antipsychotics for depression. One worry is that these medications carry a stigma in some communities, and patients may have trouble adhering to treatment if they feel uncomfortable with the medications they are using. Another issue is the known side effects of these medications, some of which can be quite severe. While atypical antipsychotics are less dangerous, they can still cause neurological problems, some of which may be permanent.

A medical practitioner discuss the possibility of using antipsychotics for depression with a patient if they seem appropriate. The patient should review the risks and benefits with care, and get information on how the dosing will be determined. It is also an option to bring this up independently if a medical provider has not discussed the possibility of using antipsychotics for depression that doesn’t appear to be responding to treatment. Before the patient starts taking the medication, it may be necessary to conduct a thorough evaluation to check for potential risks, to make sure the drug is as safe as possible.