Matching Patient to Medication: Final Perspectives on Adjunctive Antipsychotic Therapy in MDD

In the final episode, "Matching Patient to Medication: Final Perspectives on Adjunctive Antipsychotic Therapy in MDD," the panelists explored the following critical questions:

When you sit down with a patient who has not responded adequately to one or two antidepressant trials, how do you make the treatment selection decision among the five approved options, and which patient-level factors are most determinative?

What are your final takeaways from this panel discussion?

Led by the moderator, the panelists/expert mental health experts examined key patient-level factors driving selection among the five adjunctive agents — including weight status, sleep disturbance, and general medication sensitivity — with Wilkinson noting a preference for lumateperone given its lack of weight gain and quetiapine for patients needing help with sedation who aren't already overweight, while Bhide observed these are exactly the clinical factors payers would want documented under utilization management. In closing reflections, Wilkinson emphasized the robust evidence base supporting these agents' antidepressant effects, Rhee reiterated the need for more long-term, observational research on effectiveness and safety, Bhide acknowledged that payers could do a better job examining long-term claims data in this disease state, and Thase closed by framing the class's modest but consistent benefit over placebo as reason to prioritize cost-conscious, clinically appropriate prescribing paired with careful ongoing monitoring.

Throughout the conversation, the experts provided a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

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