For Treatment-Resistant Depression, Add an Antipsychotic or Switch Antidepressants? — Physician’s First Watch
For Treatment-Resistant Depression, Add an Antipsychotic or Switch Antidepressants?
By Amy Orciari Herman
For patients with depression unresponsive to antidepressants, adding the antipsychotic aripiprazole seems modestly better than switching to the antidepressant bupropion, a JAMA study suggests.
Over 1500 Veterans Affairs patients with treatment-resistant, nonpsychotic depression were randomized to one of three treatments for 12 weeks: switch to bupropion or add bupropion or aripiprazole to the current antidepressant. Participants who achieved remission continued treatment and were followed for an additional 24 weeks to assess relapse rates.
The primary outcome — remission at 12 weeks — occurred in 22% of patients who switched to bupropion, 27% who added bupropion, and 29% who added aripiprazole. Only the difference between the bupropion-switch and aripiprazole groups was statistically significant. Relapse rates did not differ across the groups.
Aripiprazole recipients were more likely than bupropion recipients to experience somnolence, extrapyramidal effects, and weight gain, whereas bupropion was associated with more anxiety.
The authors conclude, "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."