A new study shows that for older adults with treatment-resistant depression, augmenting their current antidepressant with an antipsychotic drug is more effective than switching between antidepressants.
Aripiprazole, originally approved by the FDA in 2002 for treating schizophrenia, has also been used in lower doses as an add-on treatment for clinical depression in younger patients who do not respond to antidepressants alone.
The research, designed to determine which strategy is most effective, revealed that augmenting an antidepressant with aripiprazole helped 30% of patients with treatment-resistant depression, compared to only 20% who were switched to another solo antidepressant.
The results were published in the New England Journal of Medicine.
The study, led by Eric J. Lenze, psychology professor at Washington University in St. Louis, examined 742 people aged 60 and older with treatment-resistant depression, meaning their depression had not responded to at least two different antidepressant medications.
The study was designed in two phases. In the first phase, patients taking an antidepressant such as Prozac, Lexapro, or Zoloft were divided into three groups.
One group added aripiprazole (Abilify) to their current antidepressant, the second group added bupropion (brand names Wellbutrin or Zyban) to their current antidepressant, and the third group switched from their current antidepressant to bupropion entirely.
Over ten weeks, patients who added aripiprazole to their current antidepressant experienced the best overall outcomes.
The second phase of the study included 248 participants.
In this phase, patients taking antidepressants such as Prozac, Lexapro, and Zoloft were treated with lithium or nortriptyline—medications that were widely used before newer antidepressants were approved over two decades ago.
The rates of alleviating depression in this phase were low, about 15%, with no clear winner between augmentation with lithium or switching to nortriptyline.
The results highlight the complexity of treatment-resistant depression, particularly in older adults, many of whom are already on multiple medications for other health conditions.
This makes the process of switching to new antidepressants or adding other psychiatric drugs more complicated.
Furthermore, depression and anxiety in older adults can accelerate cognitive decline, emphasizing the need for more effective treatment strategies.
While antidepressants are highly helpful for the majority of people suffering from clinical depression, a sizable group does not respond to two treatments, illustrating the need for further research to determine effective treatments for this population.
The findings were presented at the annual meeting of the American Association for Geriatric Psychiatry in New Orleans.
Coauthors come from several institutions, including Columbia University, UCLA, the University of Pittsburgh, and the University of Toronto.
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The study was published in the New England Journal of Medicine.
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