{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T05:01:15Z","timestamp":1790226075935,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T00:00:00Z","timestamp":1715299200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["World Psychiatry"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:p>Psychotic depression (PD) is a severe mental disorder leading to functional disability and high risk of suicide, but very little is known about the comparative effectiveness of medications used in its maintenance treatment. The objective of this study was to investigate the comparative effectiveness of specific antipsychotics and antidepressants, and their combinations, on the risk of psychiatric hospitalization among persons with PD in routine care. Persons aged 16\u201065 years with a first\u2010time diagnosis of PD were identified from Finnish (years 2000\u20102018) and Swedish (years 2006\u20102021) nationwide registers of inpatient care, specialized outpatient care, sickness absence, and disability pension. The main exposures were specific antipsychotics and antidepressants, and the main outcome measure was psychiatric hospitalization as a marker of severe relapse. The risk of hospitalization associated with periods of use vs. non\u2010use of medications (expressed as adjusted hazard ratio, aHR) was assessed by a within\u2010individual design, using each individual as his\/her own control, and analyzed with stratified Cox models. The two national cohorts were first analyzed separately, and then combined using a fixed\u2010effect meta\u2010analysis. The Finnish cohort included 19,330 persons (mean age: 39.8\u00b114.7 years; 57.9% women) and the Swedish cohort 13,684 persons (mean age: 41.3\u00b114.0 years; 53.5% women). Individual antidepressants associated with a decreased risk of relapse vs. non\u2010use of antidepressants were bupropion (aHR=0.73, 95% CI: 0.63\u20100.85), vortioxetine (aHR=0.78, 95% CI: 0.63\u20100.96) and venlafaxine (aHR=0.92, 95% CI: 0.86\u20100.98). Any long\u2010acting injectable antipsychotic (LAI) (aHR=0.60, 95% CI: 0.45\u20100.80) and clozapine (aHR=0.72, 95% CI: 0.57\u20100.91) were associated with a decreased risk of relapse vs. non\u2010use of antipsychotics. Among monotherapies, only vortioxetine (aHR=0.67, 95% CI: 0.47\u20100.95) and bupropion (aHR=0.71, 95% CI: 0.56\u20100.89) were associated with a significantly decreased risk of relapse vs. non\u2010use of both antidepressants and antipsychotics. In an exploratory analysis of antidepressant\u2010antipsychotic combinations, a decreased relapse risk was found for amitriptyline\u2010olanzapine (aHR=0.45, 95% CI: 0.28\u20100.71), sertraline\u2010quetiapine (aHR=0.79, 95% CI: 0.67\u20100.93) and venlafaxine\u2010quetiapine (aHR=0.82, 95% CI: 0.73\u20100.91) vs. non\u2010use of antidepressants and antipsychotics. Benzodiazepines and related drugs (aHR=1.29, 95% CI: 1.24\u20101.34) and mirtazapine (aHR=1.17, 95% CI: 1.07\u20101.29) were associated with an increased risk of relapse. These data indicate that, in the maintenance treatment of PD, bupropion, vortioxetine, venlafaxine, any LAI, clozapine, and only few specific antidepressant\u2010antipsychotic combinations are\u00a0associated with a decreased risk of relapse. These findings challenge the current recommendation by treatment guidelines to combine an antipsychotic with an antidepressant (without further specification) as standard treatment in PD.<\/jats:p>","DOI":"10.1002\/wps.21205","type":"journal-article","created":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T07:48:11Z","timestamp":1715327291000},"page":"276-284","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Real\u2010world effectiveness of antidepressants, antipsychotics and their combinations in the maintenance treatment of psychotic depression. Evidence from within\u2010subject analyses of two nationwide cohorts"],"prefix":"10.1002","volume":"23","author":[{"given":"Heidi","family":"Taipale","sequence":"first","affiliation":[{"name":"Department of Forensic Psychiatry University of Eastern Finland, Niuvanniemi Hospital  Kuopio Finland"},{"name":"Department of Clinical Neuroscience Karolinska Institutet  Stockholm Sweden"},{"name":"School of Pharmacy University of Eastern Finland  Kuopio Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Lieslehto","sequence":"additional","affiliation":[{"name":"Department of Forensic Psychiatry University of Eastern Finland, Niuvanniemi Hospital  Kuopio Finland"},{"name":"Department of Clinical Neuroscience Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markku","family":"L\u00e4hteenvuo","sequence":"additional","affiliation":[{"name":"Department of Forensic Psychiatry University of Eastern Finland, Niuvanniemi Hospital  Kuopio Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksi","family":"Hamina","sequence":"additional","affiliation":[{"name":"Department of Forensic Psychiatry University of Eastern Finland, Niuvanniemi Hospital  Kuopio Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antti","family":"Tanskanen","sequence":"additional","affiliation":[{"name":"Department of Forensic Psychiatry University of Eastern Finland, Niuvanniemi Hospital  Kuopio Finland"},{"name":"Department of Clinical Neuroscience Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellenor","family":"Mittendorfer\u2010Rutz","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tapio","family":"Palj\u00e4rvi","sequence":"additional","affiliation":[{"name":"Department of Forensic Psychiatry University of Eastern Finland, Niuvanniemi Hospital  Kuopio Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Solmi","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of Ottawa  Ottawa ON Canada"},{"name":"Regional Centre for Treatment of Eating Disorders and On Track: Champlain First Episode Psychosis Program, Department of Mental Health Ottawa Hospital  Ottawa ON Canada"},{"name":"Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa  Ottawa ON Canada"},{"name":"Department of Child and Adolescent Psychiatry Charit\u00e9 Universit\u00e4tsmedizin  Berlin 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Psychiatry University of Eastern Finland, Niuvanniemi Hospital  Kuopio Finland"},{"name":"Department of Clinical Neuroscience Karolinska Institutet  Stockholm Sweden"},{"name":"Center for Psychiatry Research Stockholm City Council  Stockholm Sweden"},{"name":"Neuroscience Center University of Helsinki  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,5,10]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291717002501"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2022.140"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2022.10.035"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.11r07324"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbt046"},{"key":"e_1_2_6_7_1","first-page":"CD004044","article-title":"Pharmacological treatment for psychotic 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