title: Augmentation of phenelzine with aripiprazole and quetiapine in a treatment-resistant patient with psychotic unipolar depression: case report and literature review.
abstract: Irreversible monoamine oxidase inhibitor (MAOI) antidepressants have significant efficacy in treatment-resistant unipolar depression, but in some instances patients may not achieve remission. Among the adjunctive and augmentation strategies, certain second-generation antipsychotics (SGAs) have approval for inadequate responders to antidepressant therapy, including aripiprazole, brexpiprazole, and quetiapine, with lurasidone and the olanzapine/fluoxetine combination indicated for bipolar depression. Clinicians may eschew SGA options in part due to the limited literature on SGA-MAOI combinations, with only one published case involving aripiprazole, and none for olanzapine, lurasidone, or brexpiprazole. In addition to the limited publication history on SGA-MAOI treatment, clinicians may also be deterred by uncertainty regarding SGA mechanisms and the risk of serotonin syndrome or other adverse outcomes. This paper describes the case of a 54-year-old male with a history of psychotic unipolar depression treated with a combination of phenelzine, aripiprazole, and quetiapine, and reviews the 12 published cases of SGA-MAOI combination therapy with a focus on the pharmacological basis for serotonin syndrome, and the SGA mechanisms that should not be associated with a risk for this syndrome.
authors.affiliation: California Department of State Hospitals,Psychopharmacology Resource Network,Department of State Hospitals-Patton,Patton,California 92369,USA.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Meyer
authors.affiliation: California Department of State Hospitals,Psychopharmacology Resource Network,Department of State Hospitals-Patton,Patton,California 92369,USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Cummings
authors.affiliation: California Department of State Hospitals,Psychopharmacology Resource Network,Department of State Hospitals-Patton,Patton,California 92369,USA.
authors.forename: George
authors.initials: G
authors.lastname: Proctor
mesh_terms: D000341:Affective Disorders, Psychotic / Q000188:drug therapy*; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000068180:Aripiprazole / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D008875:Middle Aged; D008996:Monoamine Oxidase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D010624:Phenelzine / Q000008:administration & dosage / Q000627:therapeutic use; D000069348:Quetiapine Fumarate / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D008996:Monoamine Oxidase Inhibitors; D000069348:Quetiapine Fumarate; D000068180:Aripiprazole; D010624:Phenelzine
keywords: Monoamine oxidase inhibitor; antipsychotic; aripiprazole; depression; quetiapine