March 24, 2004 — Medications used to help alleviate symptoms of schizophrenia may help severely depressed people who do not respond to initial treatment, too. If confirmed, the findings may lead to new treatment options for hard-to-treat depression.

The small study involved people who suffered from major depressive disorder and who failed to respond to prior use of medications used to treat depression. Half of the study participants improved when the antipsychotic drug, Geodon (ziprasidone) — used to treat schizophrenia — was combined with a serotonin reuptake inhibitor (SSRI), the most widely used type of drug to treat depression.

While encouraged by the findings, researcher George Papakostas, MD, says testing must be duplicated in larger, more rigorously designed studies before the combination treatment can be recommended for use in people with depression.

He says Geodon works significantly different from other antipsychotic drugs similar to it. He also says it works differently from other available antidepressants. “But this study is only suggestive of this treatment being effective. It is far from definitive.”

Study Findings

Geodon is one of the newer medication classes known as atypical antipsychotics, which are the most widely prescribed drugs for the treatment of schizophrenia.

In the newly published study, funded by Geodon manufacturer, Pfizer Pharmaceuticals, 20 patients with major depressive disorder resistant to treatment with an SSRI alone were treated with an SSRI plus Geodon for six weeks.

Ten of the patients responded to the combination treatment, often within a week of the antipsychotic drug’s addition. But seven patients withdrew from the study, with four (20%) dropping out because of Geodon-related side effects. The most commonly reported side effects included fatigue and tiredness, sleep disturbance, dry mouth, and restlessness.

The findings were reported in the February issue of the Journal of Clinical Psychiatry.

Other Research

Mental health researcher A. John Rush, MD, tells WebMD that atypical antipsychotic drugs such as Geodon are increasingly being combined with other medications to treat severely depressed patients who fail to respond to SSRIs alone.

Rush is the principal investigator of a largest trial ever to examine treatment options for people with depression who do not respond to initial therapies. The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study includes roughly 4,000 people, but atypical antipsychotic medications are not among the drugs being studied in this trial.

“The atypicals were not really on the radar screen for depression when we launched the study four years ago, but if the study is extended we would certainly like to add them,” the University of Texas Southwestern psychiatry professor tells WebMD. “Treatment-resistant depression is much more common than we thought just five or 10 years ago and there is a real need to identify therapies that will help these patients.”