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Aripiprazole effective for treatment-resistant depression in older adults

Adding aripiprazole to existing treatment was effective in achieving and sustaining remission for treatment-resistant depression, according to data published in The Lancet.

Findings also showed aripiprazole treatment demonstrated tolerability concerns in some patients, Eric J. Lenze, MD, Washington University School of Medicine, and colleagues reported.

"Most older adults with depression receive treatment in general medical settings, and the geriatric medical health workforce projections show that most older adults with depression will continue to be treated chiefly in the primary care sector," Lenze and colleagues wrote. "A major problem is treatment resistance to first-line therapies: 55-81% of older adults with major depressive disorder fail to remit with a selective serotonin reuptake inhibitor (SSRI) or a serotonin-norepinephrine reuptake inhibitor (SNRI)."

Eric J. Lenze

The researchers conducted a randomized, double-masked, placebo-controlled study of aripiprazole in patients aged older than 60 years and with treatment-resistant depression. They began the study with 468 participants with depression and treated them with venlafaxine to establish treatment resistance. Patients were treated for at least 12 weeks, with a minimum dosage of 150 mg per day and maximum of 300 mg per day. Remission was defined as a score of 10 or less on the Montgomery Asberg Depression Rating Scale (MADRS) at the last two visits.

Lenze and colleagues randomly assigned the 181 treatment-resistant patients to add either aripiprazole or a placebo for 12 weeks. Patients began with a 2 mg per day dose and were titrated to a 10 mg target dose which was increased to 15 mg per day as needed. Patients who achieved remission in the initial 12 weeks were followed for an additional 12 weeks to assess remission stability.

The researchers assessed MADRS scores as well as any changes in the Scale of Suicidal Ideation, the 36-item Medical Outcome Survey and the Hamilton Depression Rating Scale 17-item (Ham-D).

Results showed 44% of patients on aripiprazole achieved remission, compared with 29% of patients taking the placebo. Additionally, patients who received aripiprazole demonstrated a larger decrease in MADRS and Ham-D scores and shorter time to remission compared with placebo patients. Researchers reported that higher numbers of patients receiving aripiprazole experienced akathisia (26%) and parkinsonism (17%), compared with 12% and 2% of patients receiving placebo, respectively.

"Our results showed that aripiprazole is moderately effective in older adults with treatment-resistant depression," Lenze and colleagues wrote. "Clinicians prescribing this medication should be aware of its propensity to cause akathisia and Parkinsonism. However, the potential benefits of remission from depression and greater reductions in suicidal ideation outweigh these usually mild adverse events." – by Chelsea Frajerman Pardes

Disclosures: Lenze has received research support from the National Institute of Mental Health, National Institute on Aging, National Center for Complementary and Integrative Health, Roche, Lundbeck, the Sidney R. Baer Foundation, the Taylor Family Institute for Innovative Psychiatric Research, the Barnes-Jewish Foundation and the McKnight Brain Research Foundation. Please see the full study for a list of all other authors' relevant financial disclosures.