Treatment Approaches Compared for MDD Unresponsive to Antidepressants
Small increased likelihood of remission at 12 weeks in patients with major depressive disorder
HealthDay News — For patients with major depressive disorder (MDD), augmentation with aripiprazole is associated with an increased likelihood of remission, according to a study published in the July 11 issue of the Journal of the American Medical Association.
Somaia Mohamed, MD, PhD, from the VA Connecticut Healthcare System in West Haven, and colleagues examined the relative effectiveness and safety of three treatments for MDD in patients unresponsive to at least one antidepressant course. Patients were randomly assigned to switch to a different antidepressant, bupropion (switch group, 511 patients); augment current treatment with bupropion (augment-bupropion group, 506 patients); or augment with an atypical antipsychotic, aripiprazole (augment-aripiprazole group, 505 patients) for 12 weeks and up to 36 weeks (acute treatment and continuous phases).
The researchers found that at 12 weeks, the remission rates were 22.3, 26.9, and 28.9% for the switch, augment-bupropion, and augment-aripiprazole groups; the augment-aripiprazole group exceeded the switch group in remission (relative risk, 1.3). The augment-aripiprazole group had greater response compared with the switch or augment-bupropion groups (74.3 versus 62.4% [relative risk, 1.19] and 65.6% [relative risk, 1.13], respectively). There were no significant treatment differences for relapse. The bupropion groups had more anxiety (24.3, 22.5, and 16.6% in the switch, augment-bupropion, and augment-aripiprazole groups, respectively).
"Given the small effect size and adverse effects associated with aripiprazole, further analysis including cost-effectiveness is needed to understand the net utility of this approach," the authors write.
Several authors disclosed financial ties to pharmaceutical companies, including Bristol-Myers Squibb, which provided aripiprazole for use in the study.