Antidepressant Augmentation Examined in Seniors With Depression

MONDAY, March 6, 2023 (HealthDay News) — Augmentation of existing antidepressants with aripiprazole improves well-being among older adults with treatment-resistant depression, according to a study published online March 3 in the New England Journal of Medicine.

Eric J. Lenze, M.D., from the Washington University School of Medicine in St. Louis, and colleagues conducted a two-step trial involving adults aged 60 years or older with treatment-resistant depression. A total of 619 patients were enrolled in step 1 and randomly assigned to augmentation of existing antidepressant medication with aripiprazole, augmentation with bupropion, or a switch from existing antidepressant medication to bupropion (211, 206, and 202 patients, respectively). Those who did not benefit from or were ineligible for step 1 were randomly assigned to augmentation with lithium or a switch to nortriptyline in step 2 (127 and 121 patients, respectively).

The researchers found that in step 1, the well-being scores improved by 4.83, 4.33, and 2.04 points, respectively, in the aripiprazole-augmentation, bupropion-augmentation, and switch-to-bupropion groups, with a significant difference seen between the aripiprazole-augmentation group and the switch-to-bupropion group. Remission occurred in 28.9, 28.2, and 19.3 percent of patients, respectively. The highest rate of falls was seen with bupropion augmentation. In step 2, well-being scores improved by 3.17 and 2.18 points, respectively, with lithium augmentation and switch to nortriptyline. Remission occurred in 18.9 and 21.5 percent, respectively, and the rate of falls was similar between the groups.

“Given the high prevalence of depression and the extent of nonresponses to first-line therapies, treatment resistance is a great clinical concern and has poor outcomes,” write the authors of an accompanying editorial. “The findings from this trial should help clinicians and older adult patients make informed decisions regarding the next steps, in the absence of a response to conventional pharmacologic approaches.”

Several authors disclosed financial ties to the biopharmaceutical industry.

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