Bipolar Dream :
Antipsychotic Drugs as Antidepressants
by Gordon Parker

Antipsychotic Drugs as Antidepressants

by Prof. Gordon Parker

Antipsychotic drugs were developed to primarily treat delusions and hallucinations but comparative analyses of the ‘old’ antipsychotic drugs with the ‘old ‘antidepressants showed many years ago that the antipsychotic drugs were equally effective and, when they worked, that they often worked rapidly and faster than antidepressants. This could have argued for their wider use as antidepressant drugs per se. However, their take up as antidepressants did not occur to any great degree, presumably because clinicians were concerned about side-effects, and tardive dyskinesia in particular.

The ‘new’ antipsychotic drugs (often called the ‘atypical antipsychotics’) appear to have similar or even slightly superior efficacy compared to the older antipsychotic drugs and fewer side-effects, with the risk of tardive dyskinesia being distinctly less.

In the last few years we have noticed that the addition of an atypical antipsychotic to an antidepressant drug may be associated with a marked improvement. In essence, while I would still prescribe a single antidepressant by itself, if the depressed individual had not improved with that drug and with a somewhat broader second antidepressant trialled, I would then often add an atypical antipsychotic in a number of instances, particularly when the patient has a more ‘biological’ depression. I sometimes note rapid improvement with a low-dose of the atypical antipsychotic when added to the antidepressant, and generally tend to cease the atypical within a week after recovery. In some other situations, the individual may need a higher dose of the atypical and for an extended period, as withdrawing it may cause relapse. The extended use of an atypical psychotic together with an antidepressant is not an orthodox strategy and over the next few years we should anticipate guidelines for the use of atypical antipsychotics to be developed and considered carefully in the management of depression.