Aripiprazole Augmentation of Antidepressants for the Treatment of Partially Responding and Nonresponding Patients With Major Depressive Disorder
J Clin Psychiatry 2005;66(10):1216-1220
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: To determine the efficacy and
tolerability of aripiprazole, a dopamine
D2 and 5-HT1A receptor partial agonist, as augmentation of
antidepressant treatment of partially responding
and nonresponding patients with major depressive disorder.
Method: Fifteen patients with major
depressive disorder (diagnosed with a
site-generated form described in the text) and an
incomplete response or no response to >= 8 weeks of
antidepressant (selective serotonin reuptake
inhibitor, venlafaxine, or bupropion) monotherapy
were treated with aripiprazole augmentation in an
8-week, open-label study. Data were gathered from July 2003 to March 2004.
Results: The mean duration of
antidepressant monotherapy at baseline was 43.1 weeks.
At baseline, mean Clinical Global Impressions-Severity of Illness scale and Hamilton Rating
Scale for Depression (HAM-D) scores were 4.3 and 18.9, respectively. After initiation of
aripiprazole augmentation, 6 of 15 patients achieved
remission (HAM-D score <= 7) at week 1, and 9 of 15
patients remitted by week 2. All 8 completers achieved remission by study endpoint. Akathisia in 2 patients who withdrew prematurely
prompted a reduction in the starting dose of
aripiprazole from 10 mg/day to 2.5 mg/day, resulting in a
50% reduction in attrition due to akathisia (2/7
withdrew due to akathisia with the 10-mg starting dose, 1/8 withdrew due to akathisia with the
2.5-mg starting dose). Discontinuation rates after
4 weeks of treatment were lower for the 2.5-mg starting dose (1/8 patients) than for the
10-mg starting dose (3/7 patients). Overall
discontinuation rates at endpoint were lower for the
2.5-mg dose (3/8 patients) than the 10-mg dose (4/7
patients). Response to aripiprazole augmentation did not appear to be related to the
antidepressant used at study initiation.
Conclusion: Aripiprazole is an effective
augmentation strategy for improving therapeutic response in patients with treatment-resistant
major depressive disorder when administered in
combination with standard antidepressant therapy. Based on this clinical signal, a double-blind,
placebo-controlled trial is warranted.