Augmentation With Aripiprazole Benefits Older Adults With Treatment-Resistant Depression
Antidepressant augmentation with aripiprazole over 10 weeks improved well-being more than switching to bupropion in older adults with treatment-resistant depression, according to study results published in the New England Journal of Medicine.
“Augmentation of existing antidepressants with aripiprazole was associated with a numerically higher incidence of remission. Among patients in whom augmentation or a switch to bupropion failed, changes in well-being and the occurrence of remission with lithium augmentation or a switch to nortriptyline were similar,” explained corresponding author Eric J. Lenze, MD, of the Washington University School of Medicine Department of Psychiatry, St. Louis, Missouri, and coauthors.
To investigate the issue, researchers conducted an open-label, randomized trial that focused on patients with treatment-resistant depression who were at least 60 years old.
The first part of the study included 619 patients. Among them, 211 were assigned their current antidepressant augmented with aripiprazole, 206 were assigned their current antidepressant augmented with bupropion, and 202 were assigned to switch from their current antidepressant to bupropion over approximately 10 weeks.
Well-being scores, which were measured via the National Institutes of Health Toolbox Positive Affect and General Life Satisfaction subscales, improved 4.83 points in the aripiprazole augmentation group, 4.33 points in the bupropion augmentation group, and 2.04 points in the bupropion switch group, according to the study. Rates of remission were 28.9% in the aripiprazole augmentation group, 28.2% in the bupropion-augmentation group, and 19.3% in the bupropion switch group. Falls were most frequent in the bupropion augmentation group.
The second part of the study included 248 participants who did not benefit from the first 10 weeks of the study. Among them, 127 were assigned their current antidepressant augmented with lithium, and 121 were assigned to switch from their current antidepressant to nortriptyline over 10 weeks.
Specifically, well-being improved 3.17 points and rates of remission were 18.9% in the lithium augmentation group. In the nortriptyline switch group, well-being improved 2.18 points, and rates of remission were 21.5%. Rates of falling, too, were similar between groups.