J Korean Soc Biol Ther Psychiatry.  2019 Jun;25(2):138-151. 10.0000/jksbtp.2019.25.2.138.

Augmentation of Aripiprazole versus Bupropion on Specific Symptoms of Depression in Older Adult Patients : A Post-Hoc, Multi-Center, Open-Label, Randomized Study

Affiliations
  • 1Department of Psychiatry, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Korea. annemyanne@hanmail.net
  • 2Department of Psychiatry, Dongguk University Gyeongju Hospital, Gyeongju, Korea. nostre6@msn.com
  • 3Department of Neuropsychiatry, Daegu Fatima Hospital, Daegu, Korea.
  • 4Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Korea.
  • 5Department of Psychiatry, Kyungpook National University School of Medicine, Daegu, Korea.
  • 6Department of Neuropsychiatry, College of Medicine, Pochon Cha University, Cha Hospital, Gumi, Korea.

Abstract

OBJECTIVES: The purpose
of this study was to compare aripiprazole versus bupropion augmentation therapy in older adult patients with major depressive disorder unresponsive to selective serotonin reuptake inhibitors(SSRIs).
METHODS
This is a post-hoc analysis of a 6-week, randomized prospective open-label multi-center study in thirty older adult patients with major depressive disorder. Participants were randomized to receive aripiprazole(N=16, 2.5–10mg/day) or bupropion(N=14, 150–300mg/day) for 6 weeks. Montgomery Asberg Depression Rating Scale (MADRS), 17-item Hamilton Depression Rating scale(HAM-D17), Iowa Fatigue Scale, Drug-Induced Extrapyramidal Symptoms Scale, Psychotropic-Related Sexual Dysfunction Questionnaire scores, and Clinical Global Impression-Severity (CGI-S) were obtained at baseline and after one, two, four, and six weeks. Changes on individual items of HAM-D17 were assessed as well as on composite scales(anxiety, insomnia and drive), and on four core subscales that capture core depression symptoms.
RESULTS
There was a significantly greater decrease in MADRS scores in aripiprazole group compared to bupropion group at 4(p<0.05) and 6(p<0.05) weeks. There were significantly higher response rate at week 4(p<0.05) and 6(p<0.05) and remission rate at week 6 in aripiprazole group compared to bupropion group. Individual HAM-D17 items showing significantly greater change with adjunctive aripiprazole than bupropion: insomnia, late(ES=0.81 vs. −0.24, p=0.043), psychomotor retardation(ES=1.30 vs. 0.66, p=0.024), general somatic symptoms(ES=1.24 vs. 0.00, p=0.01). On three composite scales, adjunctive aripiprazole was significantly more effective than bupropion with respect to mean change for drive(p=0.005).
CONCLUSION
Results of this study suggested that aripiprazole augmentation have superior efficacy in treating general and core symptoms of depression in older adult patients. Aripiprazole augmentation is associated with greater improvement in specific symptoms of depression such as psychomotor retardation, general somatic symptoms and drive.

Keyword

Major depressive disorder; The adult patients; Aripiprazole; Bupropion
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