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. Method: 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. Conclusion: 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 longterm safety and efficacy of these medications in combination with antidepressants.