Skip to main content

Factors associated with antipsychotic use in non-psychotic depressed patients: results from a clinical multicenter survey

Abstract

Background

The combination of antipsychotics is not well studied among non-psychotic major depressive disorder (MDD). This study aims to explore the antipsychotics use in this population and its associated factors.

Methods

This cross-sectional and multi-site study was conducted in 11 sites of China. one Thousand five hundred three eligible MDD patients after 8–12 weeks of antidepressant treatment were included consecutively. A structured questionnaire was used to obtain socio-demographic data and medical histories. The Chinese version of the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR), the Patient Health Questionnaire-15 (PHQ-15) and the Sheehan Disability Scale (SDS) were used for patient self-rating. Logistic regression model was used to explore the associated factors that could potentially be influential for the use antipsychotic augmentation.

Results

Overall, quetiapine (43.4%) was the most commonly used as an adjunct to antidepressants, followed by olanzapine (38.8%). And antipsychotics were commonly combined with escitalopram (23.1%), venlafaxine (21.7%), sertraline (14.8%). The factors influencing the combination of antipsychotics in non-psychotic depressed patients included service setting (OR = 0.444; p < 0.001; 95%CI = 0.338–0.583), comorbidity of physical illness (OR = 1.704; p < 0.001; 95%CI = 1.274–2.278), PHQ level (OR = 0.680; p < 0.001; 95%CI = 0.548–0.844), SDS level (OR = 1.627; p < 0.001; 95%CI = 1.371–1.930) and antidepressants co-treatment (OR = 2.606; p < 0.001; 95%CI = 1.949–3.485).

Conclusions

Antipsychotics use is common among non-psychotic MDD patient. Service setting, comorbidity of physical illness, somatic symptoms, social functioning and engagement, and antidepressants co-treatment could be the factors associated with the antipsychotics use in MDD patients.

Peer Review reports

Introduction

According to WHO estimates - major depressive disorder (MDD) is the leading cause for disability worldwide, with about 350 million affected people [1]. The lifetime prevalence of MDD in China was 3.4% [2]. Antidepressants are the cornerstone of depression treatment, being recommended as first-line treatment in many MDD guidelines [3,4,5]. However, antidepressant monotherapy solely may result in incomplete remission of MDD in some patients which consequently lead to chronicity, residual symptoms and treatment resistance [6,7,8,9]. Because of the acts on multiple receptor systems of the antipsychotics augmentation, antipsychotics is a recommended strategy for severe episode, inadequate response to monotherapy or treatment resistant MDD [3,4,5]. Moreover, there is a growing body of evidence that supports the use of atypical antipsychotics as augmentation agents for nonpsychotic MDD [10].

Even though there is some evidence supporting the use of atypical antipsychotics as augmentation strategy in non-psychotic MDD, discussion on the risk-benefit-ratio of this strategy have been controversial [9, 11,12,13,14,15]. The benefits of quetiapine and aripiprazole as augmentation strategy are established for MDD, and they have been approved by the Food and drug administration as adjunctive treatment for MDD [16]. In terms of pharmacological mechanism, both antipsychotics have blocking effect on 5-hydroxytryptamine (5-HT) receptors, improving anxiety, depression, attention and kinetic energy [9]. However, previous studies found that the interaction of antidepressants and antipsychotics increases the risk of adverse events [15]. Therefore, as the synergist of antidepressant treatment, antipsychotics use in the treatment of MDD still need further systematic research [9].

It is of interest to examine whether MDD patients benefit from antipsychotic augmentation strategies in clinical setting. In view of very limited empirical research on regarding the associated factors of antipsychotics use in MDD patients. In view of very limited empirical research on regarding the associated factors of antipsychotics use in MDD patients, and the findings has never been examined in a real-world setting. Therefore, the aims of the study were to investigate the rate of antipsychotics augmentation with antidepressants in non-psychotic depressed patients in clinical settings; and to explore the factors associated with antipsychotics augmentation.

Methods

Participants and setting

This study was part of a cross-sectional, multi-site survey on the clinical features of MDD patients after 8–12 weeks of antidepressant treatment with or without antipsychotics (clinicians’ choice). The detail of study was reported elsewhere [17].

A total of 1503 MDD patients were enrolled in this study from September 2014 to July 2015 at 11 sites including psychiatric hospitals and general hospitals in Beijing, Shanghai, Guangzhou, Shenzhen, Nanjing, Xi’an, Shijiazhuang, and Harbin. The study was approved by the Ethics Committee of respective participating hospital. All subjects provided written informed consent to participate in the study.

Data collection

Basic socio-demographic, clinical characteristics, and service setting were collected using a data collection form designed for this study. Details on the use of psychotropics were retrospectively recorded during the past 8–12 weeks. Adjunctive use of antipsychotics was defined as simultaneous use of antipsychotics with antidepressants during past 8–12 weeks.

Depressive symptoms were measured using the Chinese version of the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR) [18, 19]. The Chinese version of the Patient Health Questionnaire-15 (PHQ-15) [20, 21] was used to measure somatic symptoms with a total score ranges from 0 to 30. The Sheehan Disability Scale (SDS) [22, 23] was used to assess social functioning and engagement, including work/school, social life/leisure activity and family life/home responsibilities.

Statistical analyses

Data were analyzed using the Statistics Analysis System (SAS 9.4). In univariate analyses, independent samples t-tests, Chi-square test, Fisher’s exact test and Wilcoxon test were used as appropriate. Logistic regression model was used to measure the independent contribution of factors that could potentially be influential for the decision to use antipsychotic augmentation, including all factors that were significant between the antipsychotic and non- antipsychotic groups or considered clinically significant, such as basic demographic and illness characteristics and treatment characteristics (antidepressants cotreatment, switch antidepressant, concomitant benzodiazepine and non-benzodiazepine). Stepwise method was used for variables screen (enter standard:p < 0.05, elimination standard:p < 0.10). The statistical significance for all tests was set at p < 0.05 (two-sided).

Results

Demographic characteristics of the patients

A total of 1503 patients with non-psychotic MDD were analyzed in this study. The mean age was 43.8 and 62.8% were female. 65.3% of MDD patients were in their first-episode. 334 (22.2%) patients were treated with antipsychotics augmentation. There was no statistically significant difference between patients with antipsychotics and patients without antipsychotics in demographic features (Table 1).

Table 1 Comparison of subjects treated concomitant with or without an antipsychotic

Comparison of patients with antipsychotics and patients without antipsychotics

There was a significant difference in the use of antipsychotic between general hospitals and psychiatry special hospitals (66.8% vs. 33.2%, p < 0.001). The severity of MDD (p = 0.002), physical comorbidity (p < 0.001) and physical symptoms (p < 0.005), and poor social function (p < 0.001) were significantly different between the patients using antipsychotics and the patients not using antipsychotics (Table 1).

Types of antipsychotics in augmentation with antidepressants

Among 334 patients with antipsychotics, dozens of patients had been treated with more than one antipsychotic during past 8–12 weeks. As shown in Table 2 of the list of antipsychotics, quetiapine (n = 168, 43.4%) was the most commonly used as adjunctive antipsychotic therapy, followed by olanzapine (n = 150, 38.8%).

Table 2 Types of antipsychotics concomitant with antidepressants in patients

Types of antidepressants used in MDD patients

Numbers of subjects had been treated with more than one antidepressant and antipsychotics during past 8–12 weeks. The most frequently used antidepressants were escitalopram (n = 439, 24.0%), venlafaxine (n = 417, 22.8%) and sertraline (n = 226, 12.4%) (Table 3). Antipsychotics were commonly combined with escitalopram (23.1%), venlafaxine (21.7%) and sertraline (14.8%).

Table 3 Types of antidepressants used in patients

Factors associated with the use of antipsychotics in multivariate analyses

The dependent variables included age, first episode, the duration of illness, service setting, comorbidity of physical illness, PHQ level, QIDS level, SDS level and antidepressants co-treatment. Logistic regression analyses revealed service setting (OR = 0.444, 95%CI: 0.338, 0.583), comorbidity of physical illness (OR = 1.704, 95%CI: 1.274, 2.278), PHQ level (OR = 0.680, 95%CI: 0.548, 0.844), SDS level (OR = 1.627, 95%CI: 1.371, 1.930) and antidepressants co-treatment (OR = 2.606, 95%CI: 1.949, 3.485) were significantly associated with the use of antipsychotics (p < 0.001) (Table 4).

Table 4 Logistic regression modeling of factors associated with use of APs with ADs

Discussion

This study explored the prescribing patterns of antipsychotics in the treatment of non-psychotic MDD in China. Our finding confirms that antipsychotics use (22.2%) was common among non-psychotic MDD patient. Quetiapine was the most commonly used in depressed patients, followed by olanzapine. There is increasing literature supporting the efficacy of add-on quetiapine or olanzapine in the treatment of MDD. Moreover, the FDA of the United States approved olanzapine and quetiapine as adjunctive agents for MDD and the combination of olanzapine with fluoxetine and is also approved for use in treatment-resistant depression [16]. Previous studies have found that quetiapine has a significant synergistic effect on antidepressants [24] and the efficacy of escitalopram and quetiapine was comparable in the treatment of MDD [25]. Moreover, escitalopram and quetiapine combination therapy reduced hypothalamic–pituitary–adrenocortical (HPA) activity, and the inhibitory effect of HPA may be the mechanism of antidepressant effects [26].

In this study, we found that antidepressants co-treatment is the leading factor associated with antipsychotics use. The guideline states that when the replacement of antidepressants is ineffective, the combination of two antidepressants with different mechanisms of action could be adopted. Approximately one third of MDD patients achieve symptom remission after antidepressant monotherapy, and switching to different antidepressant brings the cumulative remission rate to 50–55% [27]. Antidepressants co-treatment is a useful treatment option for treatment-resistant depression [28], and antipsychotics augmentation also improve the remission rate of treatment-resistant depression [27, 29, 30]. Therefore, antidepressants co-treatment often indicates treatment-resistant, which could be an associated factor with the adjunctive use of antipsychotics.

Function impairment is also associated with the severity of depression [4, 5, 31], which may lead to antipsychotics use. However, the relationship of antipsychotics uses with improving social function of depressed patients need to be studied in future follow-up studies.

Somatic symptoms and the severity of depression affect the combination of antipsychotics [32, 33]. With the standardization of treatment, many depressed patients with somatic symptoms consider using serotonin noradrenergic reuptake inhibitors (SNRIs), which have been used in the pain of diabetic neuropathy and painful physical symptoms (backaches, headaches, muscle aches) of depression. The management of pain is achieved through the noradrenergic pathway addressing the peripheral afferent nociception fibers and the rostroventromedial medulla addressed by the 5-HT pathways traversing the neo- and paleospinothalamic tracts [34, 35]. In this study, we cannot make a conclusion about the causal relationship between the severity of depression and antipsychotics use. We speculate that Antipsychotics use in this study may improve depressive symptoms. Future prospective studies should be carried out to explore the causal relationship.

Finally, we found service setting is a crucial influencing factor of antipsychotics use. General hospitals are more likely to use antipsychotics than psychiatry special hospitals. In China’s medical system, psychiatric hospitals have more alternative therapies such as modified convulsively electroconvulsive therapy (MECT), repetitive transcranial magnetic stimulation (rTMS), psychotherapy, while in most psychiatric outpatients clinics of general hospitals only drug therapy is available. Therefore, we presume that clinicians in general hospitals preferred antipsychotics augmentation in improving not only depressive symptoms but also somatic symptoms. Although psychiatric specialized hospitals are more likely to manage more challenging patients for whom augmentation strategies are more likely needed. Psychiatric specialized hospitals are professional in the management of depression, including both clinical protocol and infrastructure support compare with general medical [36]. Availability of alternative treatments in psychiatric specialized hospitals could reduce antipsychotics use. In addition, clinicians in psychiatric hospital maybe more cautious about the side effects of antipsychotics [11, 12, 15]. Moreover, the adverse effects of antipsychotics greatly affect the treatment compliance [9, 13, 37].

Limitation

There are several limitations in this study. Firstly, this study is a cross-sectional study, which cannot unequivocally establish causal relationship of antipsychotics use and the associated factors. Thus, prospective studies are needed for better assessment of implications of the associated factors with antipsychotics use. Secondly, this study is a secondary analysis of our previously reported study, and the depressed patients included were all responders with ≥50% symptom reduction determined by the visual analogue scale (VAS) [17]. Therefore, the use of antipsychotics in the patients who did not respond to treatment is unknown. Thirdly, the effect of dosage of antipsychotics and antidepressants was not considered. The dose-efficacy relationship is common in the use of drugs, that is, high dose is more effective than low dose. Therefore, low dose of antidepressants is more likely to be combined with antipsychotics. Finally, this study was unable to address the important question of whether augmentation treatment was more effective or less well tolerated than antidepressant monotherapy.

Availability of data and materials

The data analyzed in this study is subject to the following licenses/restrictions: These data are provided for the purpose of statistical reporting and analysis only. Requests to access these datasets should be directed to corresponding author, Le Xiao, xiaole@ccmu.edu.cn.

Abbreviations

MDD:

Major depressive disorder

QIDS-SR:

The Quick Inventory of Depressive Symptomatology-Self-Report

PHQ-15:

The Patient Health Questionnaire-15

SDS:

The Sheehan Disability Scale

HPA:

Hypothalamic–pituitary–adrenocortical

5-HT:

5-hydroxytryptamine

MECT:

Modified convulsively electroconvulsive therapy

rTMS:

Repetitive transcranial magnetic stimulation

References

  1. Murray PCJL, Vos PT, Lozano PR, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380(9859):2197–223. https://doi.org/10.1016/S0140-6736(12)61689-4.

    Article  PubMed  Google Scholar 

  2. Huang Y, Wang Y, Wang H, Liu Z, Yu X, Yan J, et al. Prevalence of mental disorders in China: a cross-sectional epidemiological study. Lancet Psychiatry. 2019;6(3):211–24. https://doi.org/10.1016/S2215-0366(18)30511-X.

    Article  PubMed  Google Scholar 

  3. Li Lingjiang MX. Chinese Medical Association. Chinese guidelines for the prevention and treatment of depression [J]: Chinese Medical Association; 2015.

    Google Scholar 

  4. Ravindran AV, Balneaves LG, Faulkner G, Ortiz A, Mcintosh D, Morehouse RL, et al. Canadian network for mood and anxiety treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder. Can J Psychiatr. 2016;61(9):576–87. https://doi.org/10.1177/0706743716660290.

    Article  Google Scholar 

  5. Listed N. Practice guideline for the treatment of patients with major depressive disorder (revision). American Psychiatric Association. Am J Psychiatry. 2000;157:1–45.

    Article  Google Scholar 

  6. Orsolini L, Vellante F, Valchera A, Fornaro M, Carano A, Pompili M, et al. Atypical antipsychotics in major depressive disorder; 2018.

    Book  Google Scholar 

  7. Selek S, Soares JC. Neurobiology and evidence-based review on novel therapeutic strategy for treatment-resistant depression (TRD); 2018.

    Book  Google Scholar 

  8. Morais M. Antipsychotic drugs in depression: the unexplored role of neuroplasticity. Eur Neuropsychopharmacol. 2015;25:S433–4. https://doi.org/10.1016/S0924-977X(15)30580-0.

    Article  Google Scholar 

  9. Shelton RC, Papakostas GI. Augmentation of antidepressants with atypical antipsychotics for treatment-resistant major depressive disorder. Acta Psychiatr Scand. 2010;117:253–9.

    Article  Google Scholar 

  10. Nelson JC, Papakostas GI. Atypical antipsychotic augmentation in major depressive disorder: a meta-analysis of placebo-controlled randomized trials. Am J Psychiatry. 2009;166(9):980–91. https://doi.org/10.1176/appi.ajp.2009.09030312.

    Article  PubMed  Google Scholar 

  11. Wen XJ, Wang LM, Liu ZL, Huang A, ., Liu YY, Hu JY. Meta-analysis on the efficacy and tolerability of the augmentation of antidepressants with atypical antipsychotics in patients with major depressive disorder. Braz J Med Biol Res 2014;47:605–616, 7, DOI: https://doi.org/10.1590/1414-431X20143672.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  12. Carroll BJ. Antipsychotic drugs for depression? Am J Psychiatr. 2010;167(2):216; author reply 216-219. https://doi.org/10.1176/appi.ajp.2009.09091257.

    Article  PubMed  Google Scholar 

  13. Seo H, Jung Y, Ys, Jun T, Chae J, Bahk W. Effect of augmented atypical antipsychotics on weight change in patients with major depressive disorder in a naturalistic setting. Hum Psychopharmacol. 2010;24:135–43.

    Article  Google Scholar 

  14. Lin CY, Lai TJ, Wu YH, Chen PK, Lin YF, Chien IC. Change in 1-year hospitalization of overall and older patients with major depressive disorder after second-generation antipsychotics augmentation treatment. J Affect Disord. 2018;230:118–24. https://doi.org/10.1016/j.jad.2018.01.011.

    Article  PubMed  Google Scholar 

  15. Han. Do we need to consider ethno-cultural variation in the use of atypical; antipsychotics for Asian patients with major depressive disorder? Cns Drugs. 2013;27:S47–51.

    Article  Google Scholar 

  16. Nelson JC. Optimizing outcomes in major depressive disorder via augmentation therapy--focus on the role of atypical antipsychotics. Foreword. CNS Drugs. 2013;27(Suppl 1):S3–4.

    Article  Google Scholar 

  17. Xiao L, Feng L, Zhu X-q, Yuan, Wu W-y, Ungvari. Comparison of residual depressive symptoms and functional impairment between fully and partially remitted patients with major depressive disorder: a multicenter study. Psychiatry Res. 2018;261:547.

    Article  Google Scholar 

  18. Liu J, Xiang Y-T, Wang G, Zhu X-Z, Ungvari GS, Kilbourne AM, et al. Psychometric properties of the Chinese versions of the quick inventory of depressive symptomatology - clinician rating (C-QIDS-C) and self-report (C-QIDS-SR). J Affect Disord. 2013;147(1–3):421–4. https://doi.org/10.1016/j.jad.2012.08.035.

    Article  PubMed  Google Scholar 

  19. Rush AJ, Trivedi MH, Ibrahim HM, Carmody TJ, Arnow B, Klein DN, et al. The 16-item quick inventory of depressive symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biol Psychiatry. 2003;54(5):573–83. https://doi.org/10.1016/S0006-3223(02)01866-8.

    Article  PubMed  Google Scholar 

  20. Kroenke K, Spitzer RL, Williams JBW. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med. 2002;64(2):258–66. https://doi.org/10.1097/00006842-200203000-00008.

    Article  PubMed  Google Scholar 

  21. Xiong N, Fritzsche K, Wei J, Hong X, Leonhart R, Zhao X, et al. Validation of patient health questionnaire (PHQ) for major depression in Chinese outpatients with multiple somatic symptoms: a multicenter cross-sectional study. J Affect Disord. 2015;174:636–43. https://doi.org/10.1016/j.jad.2014.12.042.

    Article  PubMed  Google Scholar 

  22. Leu SH, Chou JY, Lee PC, Cheng HC, Shao WC, Hsien WL, et al. Validity and reliability of the Chinese version of the Sheehan Disability Scale (SDS-C). Asia Pac Psychiatry. 2015;7(2):215–22. https://doi.org/10.1111/appy.12182.

    Article  PubMed  Google Scholar 

  23. Sheehan DV, Harnett-Sheehan K, Spann ME, Thompson HF, Prakash A. Assessing remission in major depressive disorder and generalized anxiety disorder clinical trials with the discan metric of the Sheehan disability scale. Int Clin Psychopharmacol. 2011;26(2):75–83. https://doi.org/10.1097/YIC.0b013e328341bb5f.

    Article  PubMed  Google Scholar 

  24. Shajahan P, ., Taylor M, . The uses and outcomes of quetiapine in depressive and bipolar mood disorders in clinical practice. J Psychopharmacol 2009;24:565–572.

    Article  Google Scholar 

  25. Nina Sarubin CN, Schmotz C, Wimmer AM, Trummer J, Lieb M, Uhr M, et al. Impact on cortisol and antidepressant efficacy of quetiapine and escitalopram in depression. Eur Psychiatry. 2014;39:141–51.

    Google Scholar 

  26. Nothdurfter C, Schmotz C, Sarubin N, Baghai TC, Laenger A, Lieb M, et al. Effects of escitalopram/quetiapine combination therapy versus escitalopram monotherapy on hypothalamic–pituitary–adrenal-axis activity in relation to antidepressant effectiveness. J Psychiatr Res. 2014;52:15–20. https://doi.org/10.1016/j.jpsychires.2014.01.013.

    Article  PubMed  Google Scholar 

  27. Wade RL, Kindermann SL, Hou Q, Thase ME. Comparative assessment of adherence measures and resource use in SSRI/SNRI-treated patients with depression using second-generation antipsychotics or L-methylfolate as adjunctive therapy. J Manag Care Pharm. 2014;20(1):76–85. https://doi.org/10.18553/jmcp.2014.20.1.76.

    Article  PubMed  Google Scholar 

  28. Dodd S, Horgan D, Malhi GS, Berk M. To combine or not to combine? A literature review of antidepressant combination therapy. J Affect Disord. 2005;89(1-3):1–11. https://doi.org/10.1016/j.jad.2005.08.012.

    CAS  Article  PubMed  Google Scholar 

  29. Williams CJ, Taylor M, Kessler D, et al. Pharmacological interventions for treatment-resistant depression in adults: Wiley; 2013. https://doi.org/10.1002/14651858.CD010557.

  30. Han C, Wang SM, Kato M, Lee SJ, Patkar AA, Masand PS, et al. Second-generation antipsychotics in the treatment of major depressive disorder: current evidence. Expert Rev Neurother. 2013;13(7):851–70. https://doi.org/10.1586/14737175.2013.811901.

    CAS  Article  PubMed  Google Scholar 

  31. Liu YH, Chen L, Su YA, Fang YR, Si TM. Is early-onset in major depression a predictor of specific clinical features with more impaired social function? Chin Med J. 2015;128(6):811–5. https://doi.org/10.4103/0366-6999.152654.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Spielmans GI, Berman MI, Linardatos E, Rosenlicht NZ, Perry A, Tsai AC. Adjunctive a typical antipsychotic treatment for major depressive disorder: a meta-analysis of depression, quality of life, and safety outcomes. PLoS Med. 2013;10(3):e1001403. https://doi.org/10.1371/journal.pmed.1001403.

  33. Sonawalla SB, Fava M. Severe depression: is there a best approach?. CNS Drugs. 2001;15(10):765-76.

  34. Barkin RL, Barkin S. The role of venlafaxine and duloxetine in the treatment of depression with decremental changes in somatic symptoms of pain, chronic pain, and the pharmacokinetics and clinical considerations of duloxetine pharmacotherapy. Am J Ther. 2005;12(5):431–8. https://doi.org/10.1097/01.mjt.0000162011.58990.94.

    Article  PubMed  Google Scholar 

  35. None. C.10.01 Depression and the body: diagnosing and treating depressed patients who present with somatic symptoms. Eur Neuropsychopharmacol. 2005;15:S661.

    Google Scholar 

  36. Bruce ML, Raue PJ, Reilly CF, Greenberg RL, Meyers BS, Banerjee S, et al. Clinical effectiveness of integrating depression care management into medicare home health. JAMA Intern Med. 2015;175:55.

    Article  Google Scholar 

  37. Edwards SJ, Hamilton V, Nherera L, Trevor N. Lithium or an atypical antipsychotic drug in the management of treatment-resistant depression: a systematic review and economic evaluation. Health Technol Assess. 2013;17(54):1–190. https://doi.org/10.3310/hta17540.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

None.

Funding

National Key Research & Development Program of China, 2016YFC1307200.

Beijing Municipal Administration of Hospitals Incubating Program, PX2018064.

Author information

Authors and Affiliations

Authors

Contributions

JJ and so on, T and so on and Britta Galling, L and so on wrote the main manuscript text, and X and so on made a statistical analysis of the data. All authors reviewed the manuscript. The author(s) read and approved the final manuscript.

Corresponding author

Correspondence to Le Xiao.

Ethics declarations

Ethics approval and consent to participate

The study protocol was approved by the Human Research and Ethics Committee of Beijing Anding Hospital in accordance with the Declaration of Helsinki and local clinical traditions and the reference number is (2014) scientific research NO.48. All subjects provided written informed consent before commencement of the study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Zhou, J., Zhu, T., Zhu, X. et al. Factors associated with antipsychotic use in non-psychotic depressed patients: results from a clinical multicenter survey. BMC Psychiatry 22, 80 (2022). https://doi.org/10.1186/s12888-021-03411-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12888-021-03411-y

Keywords

  • Major depressive disorder
  • Antipsychotics
  • Antidepressants
  • Augmentation
  • Combination