For older patients with resistant depression who fail to respond to antidepressant treatment, the addition of the atypical antipsychotic aripiprazole is superior to switching antidepressants, new research suggests. PsychTwitter
Treatment-resistant depression is common in older patients, but switching medications or adding other agents can be challenging. With higher rates of comorbidity and polypharmacy, treatment decisions in this patient population are more complex compared with younger patients.
After 10 weeks, patients' psychological well-being was assessed with the National Institutes of Health Toolbox Positive Affect and General Life Satisfaction subscales. The researchers found patients in the aripiprazole and bupropion add-on groups both improved by 4.83 points and 4.33 points, respectively. The bupropion switch group had a change of 2.04 points.
The study results showed patients who received adjunctive had the highest fall rate at 0.55 falls per patient, vs 0.33 falls per patient in the aripiprazole group, suggesting that among the three treatment options, adjunctive aripiprazole may be the best choice because of its superior efficacy and lower fall risk.
Overall,"this large, randomized study demonstrated that adding aripiprazole was a superior option for older adults with treatment-resistant depression," Lenze told"Since neither lithium nor nortriptyline were promising against treatment-resistant depression in older adults, those medications are unlikely to be helpful in most cases," he added.
With respect to fall risk, they note that bupropion was largely used in relatively high doses of 300 mg and 450 mg, despite some recent research showing little clinical benefit from increasing antidepressant doses above minimum recommendations. "Of particular significance, efficacy here is based on patient-centered outcomes and psychological well-being as a primary effectiveness outcome, which could translate into strengthened physician-patient alliance."
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