According to research published in the Archives of General Psychiatry, combination pharmacotherapy with an atypical antipsychotic together with a serotonin re-uptake inhibitor is more efficacious than treatment with an antipsychotic alone, for the treatment of major depression (MD) with psychotic features.

Researchers sought to evaluate remission rates of MD with psychotic features, in patients treated with a combination of atypical antipsychotic medication and a serotonin reuptake inhibitor, compared to patients treated with antipsychotic monotherapy, and compared response by age.

The 12-week, double-blind trial involved 259 patients with MD with psychotic features, and randomised by age (<60 years, or >/= 60 years). Patients were randomised to receive target doses of 15 to 20 mg of olanzapine per day plus masked sertraline or placebo at 150 to 200 mg per day.

 
The following results were reported:
• Treatment with olanzapine/sertraline was associated with higher remission rates during the trial than olanzapine/placebo (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.12-1.47; P < 0.001);
• 41.9% of subjects who underwent combination therapy were in remission at their last assessment compared with 23.9% of subjects treated with monotherapy (P = 0.002).
• Combination therapy was comparably superior in both younger (OR, 1.25; 1.05-1.50; P = 0.02) and older (OR, 1.34; 1.09-1.66; P = 0.01) adults.
• Younger adults gained more weight than older adults (mean [SD], 6.5 [6.6] kg vs 3.3 [4.9] kg, P = 0.001).

The researchers also concluded that “combination treatment with olanzapine plus sertraline was associated with a greater remission rate than with olanzapine monotherapy among patients with MD with psychotic features. The benefits of the combination therapy became more apparent as the 12-week trial progressed, with separation favouring olanzapine/sertraline from week 8 to the end of the trial, and thus, further studies with a longer duration are required.”