Adjunctive Aripiprazole Slightly Outperforms Bupropion in Depression
In adults with major depressive disorder who didn’t respond to an antidepressant, adding aripiprazole moderately boosted the likelihood of remission over 12 weeks, compared with switching to bupropion, according to a study published in JAMA.
“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,” the researchers added.
The study involved 1,522 patients with major depressive disorder who did not respond to at least 1 antidepressant at 35 US Veterans Health Administration medical centers. Researchers randomized participants, 85% of whom were men, to 1 of 3 different treatments: switch to bupropion, add bupropion to the current antidepressant, or add aripiprazole to the current antidepressant. Some 75% of participants completed 12 weeks of treatment.
Reexamining the Definition of Depression
Patients who added aripiprazole, the study found, had a depression remission rate of 28.9% after 12 weeks of treatment, compared with 22.3% for the bupropion-switch group and 26.9% for the group that added bupropion. Patients who added aripiprazole also had greater symptom improvement and less treatment-emergent anxiety than patients in the other 2 groups. Study discontinuation rates were lowest among patients in the added-aripiprazole group.
Drowsiness, restlessness, and weight gain, however, were more frequent in patients who added aripiprazole.
“Although weight gain did not lead to medication discontinuation [in the added-aripiprazole group], it is related to metabolic syndrome and could lead to serious health concerns in the long-term,” researchers wrote. “There is a need to further investigate the benefit-risk ratio of long-term risks of weight gain and other adverse effects compared with the benefit of modestly reducing depression.”
—Jolynn Tumolo
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