Use of antipsychotics in the treatment of major depressive disorder in the U.S. Department of Veterans Affairs.
BACKGROUND
Despite the recent U.S. Food and Drug Administration approval of aripiprazole as the first antipsychotic to be used as an adjunct to antidepressant medications in the treatment of major depressive disorder (MDD), information on the current use of antipsychotics in the treatment of MDD has not been available.


METHODS
Records of antipsychotic prescriptions for all U.S. Department of Veterans Affairs patients diagnosed with MDD (ICD-9 criteria), excluding those with comorbid schizophrenia, schizoaffective disorder, or bipolar disorder, in the fiscal year 2007 (N = 191,522) were examined. Descriptive statistics and generalized estimating equations (GEEs) were used to identify veterans' characteristics, measures of service use, and medical center characteristics that were associated with receipt of these medications and, among such users, with use of the lower doses suggested for MDD.


RESULTS
Altogether, 20.6% of veterans with MDD received antipsychotic medications, and 43% of those who did received them at the higher doses recommended for schizophrenia. GEE models showed that younger age, male gender, psychiatric comorbidities, duration of diagnosed MDD, and more intensive mental health service use were all associated with greater likelihood of receiving antipsychotics and with less likelihood of receiving them at conventional antipsychotic doses.


CONCLUSIONS
Antipsychotic medications were commonly used in the treatment of MDD prior to FDA approval, especially in the presence of comorbid mental illness and longer term MDD. Further research is needed to evaluate the long-term safety and efficacy of these medications in combination with antidepressants.
Northeast Program Evaluation Center, Department of Psychiatry, Yale School of Medicine, VA Connecticut Health Care System, West Haven, CT 06516, USA. Somaia.Mohamed@yale.edu
Somaia
S
Mohamed
Douglas L
DL
Leslie
Robert A
RA
Rosenheck
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D014481:United States; D014486:United States Food and Drug Administration; D014728:Veterans / Q000523:psychology*
D000928:Antidepressive Agents; D014150:Antipsychotic Agents