Adding an antipsychotic or antidepressant drug to pre-existing antidepressant treatment is more effective than switching to another antidepressant among older adults with treatment-resistant depression. The corresponding study was published in The New England Journal of Medicine.
Patients often do not respond to antidepressant treatments. To address this challenge, some doctors switch patients between antidepressants until they find one that works. Other doctors may prescribe another medication alongside pre-existing treatments to see if a combination therapy works. There is currently little research on how these treatment strategies affect older adults.
For the current study, researchers conducted a two-step, open-label trial involving 742 patients with treatment-resistant depression taking medications such as Prozac, Lexapro or Zoloft. In the first part of the trial, they split into three groups. The first group received aripiprazole or ‘Abilify’- an antipsychotic medication typically used for schizophrenia- alongside their existing antidepressant.
The second group received bupropion- another antidepressant, and the third group was switched from their existing antidepressant medication to bupropion alone. Patients who did not respond to any of the treatments were then put into ‘Step two’, where they were assigned either additional treatment with lithium or were switched to nortriptyline- a medication typically used to treat nerve pain and, occasionally, depression.
In Step 1, the researchers found that 28.9% of patients in the aripiprazole-augmentation group achieved remission. The same was true for 28.2% of those in the bupropion-augmentation group and 19.3% in the group that switched to bupropion. They also found that those receiving aripiprazole also achieved the greatest improvements in psychological well-being. Meanwhile, in step two, they found that 18.9% on lithium and 21.5% who switched to nortriptyline achieved remission.
“It would be beneficial to have an evidence-based strategy we can rely on to help patients feel better as quickly as possible, “ said Eric J. Lenze, MD, principal investigator and head of the Department of Psychiatry at Washington University, in a press release.
“We found that adding aripiprazole led to higher rates of depression remission and greater improvements in psychological wellbeing — which means how positive and satisfied patients felt — and this is good news. However, even that approach helped only about 30% of people in the study with treatment-resistant depression, underscoring the need to find and develop more effective treatments that can help more people,” he noted.
Sources: EurekALert, The New England Journal of Medicine