Additional Reduction of Residual Symptoms with Aripiprazole Augmentation in the Patients with Partially Remitted Major Depressive Disorder

Functioning in patients with major depressive disorder in remission: A systematic review and meta-analysis

BACKGROUND

Major depressive disorder (MDD) is one of the leading causes of burden of disease globally. We aimed to investigate whether global functioning is impaired in patients with MDD in full or partial remission compared to healthy control individuals (HC).

METHODS

We conducted a systematic review and meta-analysis according to the PRISMA guideline. We searched the databases PubMed, EMBASE and PsycINFO from January 1st 1980 to February 1st 2023. We included studies of adults with a diagnosis/former diagnosis of MDD with assessment of global functioning performed during a state of full or partial remission. The methodological quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Standardised mean differences (SMD) using random-effects models were calculated as the summary measure. We further performed meta-analyses of the mean raw score in patients with MDD for individual functioning scales.

RESULTS

Forty-two studies, comprising 17,999 patients with MDD and 35,550 HC, were included, 14 of which included both patients with MDD in full or partial remission and HC. Global functioning was lower in patients with MDD in full or partial remission compared with HC (SMD -2.00, 95 % CI: -0.9 to -3.03, 15 comparisons, I2: 99.8 %).

LIMITATIONS

Important information about the study participants and setting was not reported for most studies, or the reporting was unclear.

CONCLUSION

Patients with MDD have lower levels of functioning compared with HC also when in full or partial remission. Assessment of functioning should be an essential component of managing patients with MDD, also during remission.

Acute treatment residual depression symptoms and functional impairment among depressive patients of different age groups and education levels in China: A prospective, multicenter, randomized study

OBJECTIVE

A prospective, multicenter, randomized study evaluated the efficacy of major depressive disorder (MDD) patients after 2-3 months of acute treatment based on the dual factors of education and age.

METHODS

This study classified the included patients into four groups using two classification parameters: age (≤45 years, vs. >45 years) and education years (≤12 vs. >12). We analyzed age, gender, marital status, personal income, depression onset history, medication use, and follow-up across various groups. We evaluated residual somatic symptoms and social functioning in depression patients was conducted using the 16-item Quick Inventory of Depressive Symptomatology Self-report (QIDS-SR16), the Patient Health Questionnaire-15 (PHQ15), and the Sheehan Disability Scale (SDS).

RESULTS

In China, 16 hospitals, 553 depression patients, and 428 fulfilled the inclusion criteria. Baseline patient data revealed significant differences among the different age groups in gender, marital status, income, first onset age, physical illness, combination of antipsychotics, and benzodiazepines use (all p < .05). Statistically significant differences were observed in overall comparisons among the four groups, encompassing the QIDS-SR16 score, PHQ15 score, and various SDS parameters (all p < .05). However, no statistically significant differences (all p > .05) were found in residual somatic symptoms and social functioning parameters between different education levels (≤12 years vs. >12 years) at baseline, 3 months, and 6 months, based on total scores on the scale. Repeated measures mixed model indicates that the QIDS-SR16 assessment indicates statistical differences among various marital statuses, income levels, medical histories, and antipsychotic medication use (p < .05). Furthermore, PHQ-15 and SDS assessments reveal statistical differences between single and married/cohabiting statuses, physical comorbidities, 3 and 6 months follow-ups compared to baseline (p < .05).

CONCLUSION

This study indicates that compared to depressive patients >45 years old, those ≤45 years old often exhibit more residual depression, somatic symptoms, and severe social functional impairment; patients' education levels less influence this trend.

The Potential Role of Aripiprazole Augmentation for Major Depressive Disorder with Anxious Distress in Naturalistic Treatment Setting

Objective

: This study tried to observe clinical benefit of aripiprazole augmentation (ARPA) treatment for major depressive disorder with anxious distress (MDDA) in routine practice.

Methods

: Retrospective chart review (n = 41) was conducted for clinical benefit of ARPA in patients with MDDA in routine practice. The primary endpoint was the mean change of Hamilton Anxiety Rating scale (HAMA) total scores from baseline to the endpoint. Additional secondary endpoints were also retrieved.

Results

: The changes of primary endpoint HAMA (t = 5.731, -4.6, p = 0.001), and secondary endpoints including Hamilton Depression Rating scale (HAMD, t = 4.284, -3.4, p ＜ 0.001), Clinical Global Impression-Clinical Benefit (CGI-CB, -0.9, t = 1.821, p = 0.026), and Clinical Global Impression Score-Severity (CGI-S, t = 3.556, -0.4, p ＜ 0.001) scores were also significantly improved during the study. No significant adverse events were observed.

Conclusion

: This study has shown additional benefit of ARPA treatment for MDDA patients in routine practice. However, adequately-powered and well-controlled studies are necessary for generalization of the present findings.

Successful Early Lamotrigine and Aripiprazole Augmentation of Clomipramine in Severe Obsessive-compulsive Disorder

Lamotrigine and aripiprazole have shown efficacy as augmentation agents of serotonin reuptake inhibitors for treatment-resistant obsessive-compulsive disorder (OCD). To date, the efficacy of lamotrigine/aripiprazole augmentation has not been reported in OCD treatment. Herein, we report the case of a 37-year-old male with severe OCD and comorbid depression whose symptoms markedly improved after low-dose lamotrigine/aripiprazole augmentation to clomipramine. Our report suggests that early glutamatergic/antipsychotic augmentation contributes to rapid remission of OCD symptoms.

Additional Clinical Benefit of Agomelatine Treatment for Major Depressive Disorder in Naturalistic Treatment Setting

Objective

This study tried to observe additional benefit of agomelatine (AGO) treatment for major depressive disorder (MDD) in routine practice.

Methods

Retrospective chart review (n = 63) was conducted for additional benefit of combination with or switching to AGO in MDD patients without full remission. The primary endpoint was the mean change of Clinical Global Impression-Clinical Benefit (CGI-CB) total scores from baseline to the endpoint. Additional secondary endpoints were also collected.

Results

The changes of CGI-CB (Z = -3.073, p = 0.002) and Montgomery-Åsberg Depression Rating Scale (Z = -3.483, p < 0.001) total scores were significantly decreased from baseline to the endpoint, respectively. At the endpoint, the remission rate was 22.6% (n = 18) and 28.6% of patient had improvement in CGI-CB total scores at the endpoint. No significant adverse events were observed.

Conclusion

This study has shown additional benefit of AGO treatment as combination or switching agent for MDD patients without full remission in routine practice. However, adequately-powered and well-controlled studies are necessary for generalization of the present findings.

Efficacy of aripiprazole as adjunctive therapy in major depressive disorder with somatic symptoms: A randomized, double-blind, placebo-controlled trial with clinical and electroencephalography evidence

BACKGROUND

Somatic symptoms, which are common in major depressive disorder (MDD), are associated with a worse prognosis and increased health costs.

AIMS

This randomized, double-blind, placebo-controlled study evaluated the efficacy of aripiprazole augmentation in MDD patients with somatic symptoms.

METHODS

In all, 41 MDD patients with somatic symptoms completed the study. Participants who had been on a stable dose of antidepressants for at least 1 month were randomly assigned to receive an 8-week adjunctive treatment with either aripiprazole or placebo. The initiation dose of aripiprazole was 2 mg/day, which was later adjusted to 1-10 mg/day. The primary endpoint was the change in the Symptom Checklist-90-Revised-Somatization (SCL-90-R-SOM) score. We collected quantitative electroencephalogram data and performed spectral analyses to obtain the absolute power of frequency bands.

RESULTS/OUTCOMES

The aripiprazole group (n = 20; 2.98 ± 1.75 mg/day) showed a significant improvement in SCL-90-R-SOM scores compared to the placebo group (n = 21; F = 8.56, p = 0.006), without significant differences in changes in depression and anxiety symptoms. Compared to the control, the aripiprazole group showed a greater decrease in total alpha power (F = 7.03, p = 0.01). Changes in frontal alpha power were positively correlated with changes in SCL-90-R-SOM scores in the aripiprazole group (r = 0.53, p = 0.014).

CONCLUSIONS/INTERPRETATION

Aripiprazole adjunctive to antidepressants in patients with MDD and somatic symptoms improved somatic symptom severity without significant safety concerns, and this improvement correlated with a decrease in total and frontal alpha power.Trial Registration: https://cris.nih.go.kr; identifier: KCT0004607.