Oral antipsychotics as augmentation therapy in depression

Use of oral antipsychotics as augmentation therapy in depression

A summary of NICE guidance is given below:

• before starting an antipsychotic, check the person's baseline pulse and blood pressure, weight, nutritional status, diet, level of physical activity, fasting blood glucose or HbA1c and fasting lipids
• ccarry out monitoring as indicated in the summary of product characteristics for individual medicines, for people who take an antipsychotic for the treatment of their depression. This may include:
  • monitoring full blood count, urea and electrolytes, liver function tests and prolactin
  • monitoring their weight weekly for the first 6 weeks, then at 12 weeks, 1 year and annually
  • monitoring their fasting blood glucose or HbA1c and fasting lipids at 12 weeks, 1 year, and then annually
  • ECG monitoring (at baseline and when final dose is reached) for people with established cardiovascular disease or a specific cardiovascular risk (such as diagnosis of high blood pressure) and for those taking other medicines known to prolong the cardiac QT interval (for example, citalopram or escitalopram)
  • at each review, monitoring for adverse effects, including extrapyramidal effects (for example, tremor, parkinsonism) and prolactin-related side effects (for example, sexual or menstrual disturbances) and reducing the dose if necessary
  • being aware of any possible drug interactions which may increase the levels of some antipsychotics, and monitoring and adjusting doses if necessary
  • if there is rapid or excessive weight gain, or abnormal lipid or blood glucose levels, investigating and managing as needed.
• for people with depression who are taking an antipsychotic, consider at each review whether to continue the antipsychotic based on their current physical and mental health risks
• only stop antipsychotics in specialist mental health services, or with their advice. When stopping antipsychotics, reduce doses gradually over at least 4 weeks and in proportion to the length of treatment

For complete details then consult NICE (June 2022). Depression in adults: treatment and management

Reference:

1. NICE (June 2022). Depression in adults: treatment and management