West Haven, CT—Switching to a new drug isn’t always the best course of action for patients unresponsive to an antidepressant medication, new research suggests.
A study published in JAMA reports that adding the antipsychotic aripiprazole modestly increased the likelihood of remission from depression, compared to switching to the antidepressant bupropion.
Background information in the articles points out that fewer than a third of depression patients achieve remission with their first antidepressant.
For this study, a team led by researchers from the Veterans Affairs (VA) of the VA Connecticut Healthcare System, West Haven, CT, focused on 1,522 major depressive disorder (MDD) patients at 35 VA medical centers.
Researchers randomly assigned the patients, who were unresponsive to at least one antidepressant, to either switch to a different antidepressant, augment current treatment with bupropion, or supplement with aripiprazole for 12 weeks of treatment and 36 weeks of evaluation.
Most of the patients, aged 54 years on average, were male, and 75% completed the treatment phase. Results indicate that depression remission rates at 12 weeks were 22.3% for the switch group, 26.9% for the augment-bupropion group, and 28.9% for the augment-aripiprazole group.
The augment-aripiprazole group exceeded the switch group in remission—relative risk [RR], 1.30—but other remission comparisons were not significant, study authors note. The 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). The study found no significant treatment differences for relapse.
Researchers report that anxiety was more frequent in the two bupropion groups—24.3% in the switch group versus 16.6% in the augment-aripiprazole group—and 22.5% in augment-bupropion group.
Adverse effects more frequent in the augment-aripiprazole group were drowsiness, restlessness, and weight gain.
“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.
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