April 26, 2019 - 15:42 AMT
PanARMENIAN.Net - A new study identifies two potential medication tweaks for certain subgroups of patients with treatment-resistant major depressive disorder. Researchers published their findings online in The American Journal of Psychiatry.
“Almost two-thirds of patients with major depressive disorder do not achieve remission with initial treatments,” researchers wrote. “Thus, identifying and providing effective, feasible, and safe ‘next-step’ treatments are clinical imperatives.”
The suggestions are based on outcomes from the US Department of Veterans Affairs Augmentation and Switching Treatments for Improving Depression Outcomes (VAST-D) study. The multisite, randomized, single-blind trial included 1522 patients, most of whom were white and older, who had an inadequate response to at least one course of antidepressant treatment.
Over 12 weeks, participants received 1 of 3 possible next-step treatments: switching to sustained-release bupropion; combining sustained-release bupropion with their current medication; or augmenting their current medication with the antipsychotic aripiprazole,
In patients older than 65, researchers found augmenting with aripiprazole to be more effective in easing depressive symptoms than switching to or adding bupropion. Meanwhile, in patients with severe hypomanic symptoms, either augmenting with aripiprazole or combining their current medication with bupropion was more effective than switching to bupropion.
The study also found remission was more likely in patients who worked, who had less severe or chronic depression, experienced less anxiety, did not have symptoms of complicated grief, did not experience childhood adversity, and who had a better quality of life and positive mental health.
“If replicated, these preliminary findings could help clinicians determine which patients with depression requiring next-step treatment will benefit most from a specific augmentation, combination, or switching strategy,” researchers wrote.