We extracted data independently. For dichotomous data we calculated the odds ratio (OR) and 95% confidence interval (CI) on an intention-to-treat basis, and for continuous data the mean difference (MD), based on a random-effects model. We presented each comparison separately; we did not perform a pooled data analysis.
MAIN RESULTS: We included 28 trials with 8487 participants on five SGAs:
amisulpride,
aripiprazole,
olanzapine,
quetiapine and
risperidone.Three studies (1092 participants) provided data on
aripiprazole augmentation in MDD. All efficacy data (response n = 1092, three RCTs, OR 0.48; 95% CI 0.37 to 0.63), (MADRS n = 1077, three RCTs, MD -3.04; 95% CI -4.09 to -2) indicated a benefit for
aripiprazole but more side effects (
weight gain, EPS) .Seven trials (1754 participants) reported data on
olanzapine. Compared to placebo fewer people discontinued treatment due to inefficacy; compared to
antidepressants there were no efficacy differences,
olanzapine augmentation showed symptom reduction (MADRS n = 808, five RCTs, MD -2.84; 95% CI -5.48 to -0.20), but also more weight or
prolactin increase.Quetiapine data are based on seven trials (3414 participants). Compared to placebo,
quetiapine monotherapy (response n = 1342, three RCTs, OR 0.52; 95% CI 0.41 to 0.66) and
quetiapine augmentation (response n = 937, two RCTs, OR 0.68; 95% CI 0.52 to 0.90) showed symptom reduction, but
quetiapine induced more sedation.Four trials (637 participants) presented data on
risperidone augmentation, response data were better for
risperidone (n = 371, two RCTs, OR 0.57; 95% CI 0.36 to 0.89) but augmentation showed more
prolactin increase and
weight gain.Five studies (1313 participants) presented data on
amisulpride treatment for
dysthymia. There were some beneficial effects compared to placebo or antidepressants but tolerability was worse.
AUTHORS' CONCLUSIONS: