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May 2008

Three IM Antipsychotics
New intramuscular (IM) formulations of second-generation antipsychotics appear comparable and possibly superior in efficacy and safety to older agents, but are more expensive.

Baclofen for Alcohol Dependency with Liver Cirrhosis
Baclofen (Lioresal and others) shows efficacy in treating alcohol dependency with no adverse hepatic effects.

Antipsychotics to Treat Aggression in Patients with Intellectual Disability
A double-blind study finds little evidence to support the use of antipsychotics to treat aggression in patients with intellectual disability.

In Brief
Desvenlafaxine Approved for Depression; Olanzapine LAI Not Approved for Schizophrenia

Depression Infrequently Treated
Many patients with depression worldwide do not receive effective care.

Clozapine Plus Aripiprazole
Aripiprazole (Abilify) may be beneficial for patients with schizophrenia who respond only partially to clozapine (Clozaril and others).

Depression Infrequently Treated

May 2008

Data published in 2000 showed depression to be the fourth leading cause of disease burden worldwide.1 In the Americas, depression is the leading cause of disability-adjusted life years, representing 8% of total disease burden. Moreover, depression causes the largest amount of nonfatal disease burden in the world, accounting for almost 12% of years lived with disability.

All of these facts notwithstanding, and with depression contributing to morbidity and mortality of coexisting medical conditions, treatment often is insufficient.2 A population study in France shows that depression continues to be undertreated.

Grolleau and coworkers surveyed 36,785 people in the general population. Among them, 2111 (5.6%) qualified for a diagnosis of recurrent major depressive disorder (rMDD).3 The authors defined congruent treatment of rMDD as the lifetime use of antidepressants or mood stabilizers. Even with this easy-to-meet criterion, only one-third of subjects with rMDD had received appropriate therapy. Women, individuals with higher income, and those with a comorbid anxiety disorder were more likely to have received a congruent treatment for depression.

Interventions for depression remain far from ideal. For example, only about one-third of patients with MDD achieve remission on first treatment with an antidepressant.4 Additionally, current antidepressants cause side effects and take weeks to produce maximum benefit. Psychotherapy is helpful for many patients, but it is not acceptable to all, and many patients do not have access to therapists trained in validated methods. Nonetheless, as the STAR*D results have shown, sequential treatments of biological and psychosocial interventions give most depressed patients a reasonable chance for improvement. The fact that so many patients with depression do not have access to effective care is a worldwide public health deficiency.

1Ustün TB, Ayuso-Mateos JL, Chatterji S, Mathers C, Murray CJ: Global burden of depressive disorders in the year 2000. Br J Psychiatry 2004;184:386–392.

2Gelenberg AJ, Kocsis JH, Thase ME, et al. Revamped medication algorithm for chronic depression: Phase I open-label results. Poster presented at the 45th annual meeting of the American College of Neuropsychopharmacology, Hollywood, FL, December 3-7, 2006.

3Grolleau A, Cougnard A, Bégaud B, Verdoux H: Congruence between diagnosis of recurrent major depressive disorder and psychotropic treatment in the general population. Acta Psychiatr Scand 2008;117:20–27.

4Mann JJ: The medical management of depression. N Engl J Med 2005;353:1819-1834.