Amisulpride may help alleviate depressive symptoms in patients with major psychiatric disorder

Depression is a major public health problem. Though many antidepressant medications are available, a significant proportion of individuals are known to not respond to the first treatment. Conventional first-line treatment with antidepressants, second-generation antipsychotics (SGA), and in particular amisulpride (AMS), have been used in clinical practice.

A new study by Caroline Zangani and team revealed that treatment with amisulpride is a more efficient choice for individuals with dysthymia or depressive symptoms in the context of schizophrenia. However, further studies are needed on the efficacy and tolerability of amisulpride.

The findings of the study are published in Human psychopharmacology journal.

The objective of the study was to evaluate the efficacy and the tolerability of amisulpride, both alone and as augmentation therapy, in the treatment of depressive symptoms in individuals with any major psychiatric disorder.

The study used PubMed, Embase, PsycINFO, GreyLit, OpenGrey and ProQuest up to March 2020 for randomised controlled trials focussing on the treatment of an acute depressive episode in any major psychiatric disorder. A random-effect meta-analysis was performed to synthesize the findings on depressive symptoms (primary outcome), response rate and tolerability.

The results of the study were

• A total of11 studies retrieved including 2065 patients with a diagnosis of dysthymia (eight studies), major depression (one study) or schizophrenia (two studies).

• Amisulpride 50 mg/day was associated with a larger reduction of depressive symptoms compared to placebo (standardised mean difference [SMD] = −0.70).

• It was found to be comparable to selective serotonin reuptake inhibitors (SSRIs; SMD = −0.08, CI 95% −0.23, 0.06, I2 = 0.0%), amineptine, imipramine and amitriptyline in the treatment of dysthymia (three studies, not pooled).

• In individuals with schizophrenia, amisulpride administered at higher doses (>400 mg/day) was comparable to olanzapine and risperidone (two studies, not pooled).

• In terms of tolerability, amisulpride was superior to placebo for dysthymia (odds ratio [OR] = 3.94, CI 95% 1.07, 14.48; I2 = 0.0) and comparable with SSRIs (OR = 0.94, CI 95% 0.55, 1.62; I2 = 0.0%).

Zangani and team concluded that "Treatment with amisulpride could be a valid choice for selected individuals with dysthymia or depressive symptoms in the context of schizophrenia. More studies on the efficacy and tolerability of amisulpride are needed to draw firm conclusions on its potential benefits in other psychiatric disorders."

Reference: https://doi.org/10.1002/hup.2801