title: Aripiprazole augmentation, antidepressant combination or switching therapy in patients with major depressive disorder who are partial- or non-responsive to current antidepressants: a multi-center, naturalistic study.
abstract: There has been no studies comparing the clinical benefits of aripiprazole augmentation (AT), antidepressant combination (AC), and switching to a different antidepressant (SW) in patients with major depressive disorder (MDD) patients partially or not responding to an initial antidepressant. AT, AC, or SW was chosen by patients. The primary efficacy measure was the proportion of patients showing an improvement in the Clinical Global Impression-Clinical Benefit (CGI-CB) score at week 8. Secondary efficacy measures included changes in CGI-CB, CGI-Severity (S) and subjective satisfaction scores. Remission and responder analysis were also employed. A total of 295 patients were enrolled. The most preferred strategy was AT (n = 156, 52.9%), followed by AC (n = 93, 31.5%) and SW (n = 46, 15.6%). The improver was significantly higher in AT (74.1%) compared with AC (48.1%; p < 0.001) and similar to SW (73.5%, p = 0.948), whereas no significant difference was found between AC and SW. Similar results were also found in the most secondary endpoint measures proving a superiority of AT over AC without differences between AT and SW. Tolerability profiles were similar across the three groups; however, the mean weight gain for SW (-0.1 kg) was significantly less than that for AC (1.3 kg, p < 0.05). Patients preferred AT to AC or SW when an antidepressant was ineffective in treating their depression. Among the three treatment strategies, overall AT yielded greater clinical benefit than did AC and SW. Adequately powered, well-controlled clinical trials are strongly warranted to confirm our findings due to methodological shortcomings.
authors.affiliation: Department of Psychiatry, College of Medicine, Korea University, Seoul, Republic of Korea.
authors.forename: Changsu
authors.initials: C
authors.lastname: Han
authors.affiliation: Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea.
authors.forename: Sheng-Min
authors.initials: SM
authors.lastname: Wang
authors.affiliation: Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea.
authors.forename: Ho-Jun
authors.initials: HJ
authors.lastname: Seo
authors.affiliation: Department of Neuropsychiatry, College of Medicine, Hallym University, Seoul, Republic of Korea.
authors.forename: Boung Chul
authors.initials: BC
authors.lastname: Lee
authors.affiliation: Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Hong Jin
authors.initials: HJ
authors.lastname: Jeon
authors.affiliation: Department of Psychiatry, College of Medicine, Inje University, Seoul, Republic of Korea.
authors.forename: Won
authors.initials: W
authors.lastname: Kim
authors.affiliation: Department of Neuropsychiatry, School of Medicine, Dongguk University, Gyeongju, Republic of Korea.
authors.forename: Kyung-Phil
authors.initials: KP
authors.lastname: Kwak
authors.affiliation: Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2218 Elder St., Duram, NC, USA. Electronic address: pae@catholic.ac.kr.
authors.forename: Chi-Un
authors.initials: CU
authors.lastname: Pae
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D000068180:Aripiprazole; D003865:Major Depressive Disorder / Q000188:drug therapy*; D057915:Drug Substitution / Q000379:methods*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000627:therapeutic use*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D015363:Quinolones / Q000627:therapeutic use*
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D010879:Piperazines; D015363:Quinolones; D000068180:Aripiprazole
keywords: Augmentation; Combination; Depression; Switching