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Comparison between antidepressant augmentation and switch in depression patients

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Created On: 14/07/2023

A two-step, open-label trial compared antidepressant augmentation vs. switch for geriatric depression.

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Key take away

Aripiprazole supplementation to existing antidepressants significantly enhanced well-being compared to switching to Bupropion in older persons with treatment-resistant depression.

Background

A two-step, open-label trial compared antidepressant augmentation vs. switch for geriatric depression.

Method

Adults (aged <60 years) with depression who were resistant to treatment were included. In step 1, individuals were randomized in a 1:1:1 ratio to receive either Aripiprazole to supplement their existing antidepressants, bupropion for augmentation, or switch from their existing antidepressants to Bupropion. In step 2, those who did not respond well or who were not eligible for step 1 were randomly allocated in a 1:1 ratio with either lithium boost or a switch to nortriptyline.

Each step took around ten weeks. The National Institutes of Health Toolbox Positive Affect and General Life Satisfaction subscales were used to measure the major endpoint, which was the alteration from baseline in mental and emotional well-being. Depression remission was the secondary endpoint ascertained.

Result

A total of 619 individuals were recruited in step 1; 211 were given Aripiprazole augmentation, 206 were administered Bupropion augmentation, and 202 received a switch to Bupropion. The well-being scores elevated by 4.83, 4.33, and 2.04 points, respectively. Aripiprazole augmentation differed from the switch to the Bupropion group by 2.79 points.

There was no statistically significant difference between the groups for Aripiprazole augmentation vs. Bupropion augmentation or Bupropion augmentation versus a transition to Bupropion. Remission occurred in 28.9%, 28.2%, and 19.3% of subjects in the Aripiprazole-augmentation, Bupropion-augmentation, and switch-to-Bupropion arms, respectively. The rate of falls increased the most when Bupropion was added.

Overall, 248 individuals were included in step 2, of whom 127 received lithium augmentation and 121 switched to nortriptyline. The improvement in well-being scores was 3.17 and 2.18 points, respectively (difference, 0.99). Remission took place in 18.9% of those in the lithium-augmentation group and 21.5% of individuals in the switch-to-nortriptyline group; falling rates were comparable in both groups.

Conclusion

Compared to switching to Bupropion, Aripiprazole augmentation of current antidepressant agents in depression-affected geriatrics remarkably enhanced well-being over ten weeks, and it was also linked with a numerically greater rate of remission.

Alterations in well-being and the incidence of remission with lithium boost or a transition to nortriptyline were similar among individuals in whom boost or a switch to Bupropion was unsuccessful.