Other Popular ED Meds: Which One Is Best? Decem7 Key Facts About Atypical Antipsychotics You Should Know DecemWhat’s the Difference Between Typical vs. Most patients were women and white, and were in their 30s at first onset of depression.Abilify Dosages: Your GoodRx Guide ApWhat is Step Therapy? How to Get Insurance to Pay for Your ‘Non-Preferred’ Medication FebruCan Antidepressants and Anti-Anxiety Drugs Cause Erectile Dysfunction? FebruViagra vs. Of the 619 patients enrolled in step 1, 211 were assigned to aripiprazole augmentation, 206 to bupropion augmentation, and 202 to a switch to bupropion. While aripiprazole augmentation appeared to be of the most benefit, they advised clinicians to tailor treatment to the patient, keeping in mind side effects associated with these agents - particularly weight gain with aripiprazole. "The findings from this trial should help clinicians and older adult patients make informed decisions regarding the next steps, in the absence of a response to conventional pharmacologic approaches," the editorialists wrote. In the lithium-augmented group, psychological well-being score was improved by 3.17 points, while the nortriptyline-switch group improved by 2.18 points, which was not a significant difference.Īs for the secondary outcomes, remission rates were a bit higher in the switch-to-nortriptyline group (21.5% vs 18.9%), as was the drop in MADRS score (-5.33 vs -4.63).įall rates were slightly higher in the lithium-augmented group, though not significantly (0.47 per patient vs 0.38). These 248 patients underwent randomization into one of two groups: augmentation with lithium or a switch to nortriptyline (Pamelor). ![]() Moving on to the second step of the trial, which lasted another 10 weeks, 125 of the original 619 participants from step 1 who did not reach remission were added to a pool of another 123 participants who weren't involved in step 1, likely because they already had a trial of bupropion or aripiprazole. Extended-release bupropion was started at 150 mg per day, with a target of 300 mg per day and a maximum of 450 mg per day. Aripiprazole augmentation was started at a 2.5 mg daily dose and increased to a maximum of 15 mg. Lewis and Lewis also suggested that lower dosing of the agents than those used in the trial may help to reduce this fall risk, while still maintaining efficacy. "In a population in which the rate of falls would be expected to be lower, this relative advantage could become less clinically important in absolute terms." ![]() "In this older population, the rate of falls would be expected to be relatively high," they wrote, while also pointing out that this was a relatively "young" older population (mean age 68-69.7). They noted that while the fall rate difference between the bupropion-augmented and aripiprazole-augmented groups seems "clinically meaningful," the upper boundary of the 95% confidence interval was close to 1 and therefore "may not exclude the possibility that there is little difference in the incidence of falls." In an accompanying editorial, Gemma Lewis, PhD, and Glyn Lewis, PhD, both of University College London, emphasized the "widespread concerns" about falls in this population. The improvement in well-being scores - as measured by the National Institutes of Health Toolbox Positive Affect and General Life Satisfaction subscales - wasn't significantly different between the aripiprazole- and bupropion-augmented groups, nor the bupropion-augmented and bupropion-switch groups. "The finding that aripiprazole augmentation was more effective than a switch to bupropion is consistent with the findings of previous studies and trials of aripiprazole augmentation for treatment-resistant depression in older adults," Lenze and team wrote. ![]() The difference between the aripiprazole-augmented group and the switch-to-bupropion group reached statistical significance (difference 2.79 points, 95% CI 0.56-5.02, P=0.014, with a prespecified threshold P value of 0.017). įindings from this study were also presented at the American Association for Geriatric Psychiatry annual meeting in New Orleans. This was in comparison with a 4.33-point improvement in the group augmented with bupropion (Wellbutrin) and a 2.04-point improvement in the group that was switched to bupropion, they noted in the New England Journal of Medicine.
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