In Treatment-Resistant Depression, Augmented Therapy Could Be Beneficial

Adding aripiprazole to the treatment of patients with depression unresponsive to antidepressants is modestly better than switching to bupropion, according to a recent study.

Less than 33% of patients with depression achieve remission following their first antidepressant. In order to determine the safety and effectiveness of 3 common alternative treatments for depression, researchers conducted a study of 1522 patients from 35 US Veterans Health Administration centers who were unresponsive to at least 1 antidepressant course. All participants were randomly assigned to 1 of the 3 treatments and evaluated for up to 36 weeks.
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The 3 treatments included switching to bupropion, augmenting current treatment with bupropion, or augmenting with an atypical antipsychotic, aripiprazole.

Overall, 1137 participants completed the acute treatment phase of the study. Remission rates were 22.3% at week 12 for the switch group, 26.9% for the augment-bupropion group, and 28.9% for the augment-aripiprazole group. Response was greater for the augment-aripiprazole group (74.3%) than for either the switch group (62.4%; RR, 1.19) or the augment-bupropion group (65.6%; RR, 1.13). Anxiety was more common in the bupropion groups than the aripiprazole group, and somnolence, akathisia, and weight gain were more frequent in the aripiprazole group.

“Among a predominantly male population with major depressive disorder unresponsive to antidepressant treatment, augmentation with aripiprazole resulted in a statistically significant but only modestly increased likelihood of remission during 12 weeks of treatment compared with switching to bupropion monotherapy. 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.”

—Michael Potts

Reference:

Mohamed S, Johnson GR, Chen P, et al. Effect of antidepressant switching vs augmentation on remission among patients with major depressive disorder unresponsive to antidepressant treatment. JAMA. 2017;318(2):132-145.