https://goo.gl/bDYMHq
Many clinicians, including the JAMA editorialist, will interpret these findings to mean that atypical antipsychotics should be considered as augmentation therapy among patients with major depressive disorder unresponsive to initial treatment. We disagree. Compared to adding buproprion, atypicals did not offer an advantage, and adverse effects were more significant.
Furthermore, none of the comparator groups included a placebo arm, nor an arm that compared adding psychotherapy for the many participants who were not receiving it at baseline. At present, we still don't know if augmentation with an antipsychotic to treat major depressive disorder is any better than placebo or additional behavioral therapy.
In the face of uncertainty, our Slow Medicine philosophy favors the safer, more conservative approach. VAST-D will not change our practice. Until we see clear evidence of benefits that outweigh the harms, we don't see a role for antipsychotics for most patients with depression. For now, among patients with an inadequate response to a first antidepressant, we'll try a second antidepressant, consider enhancing behavioral therapy, or think about augmenting with the safer medication, buproprion.