Augmentation with aripiprazole or bupropion, or a switch to nortriptyline, effective for treatment-resistant depression in older adults

Clinical Question

In adults 60 years and older with treatment-resistant depression, what is the best pharmacologic approach?

Bottom line

There are several takeaways from this trial. Aripiprazole augmentation and bupropion augmentation produce similar modest improvements, and either is a reasonable option. Although injurious falls appear to be more common with bupropion, the authors inexplicably don't report weight gain and hyperglycemia, which are both known adverse effects of aripiprazole. In the second comparison, a switch to nortriptyline seems preferable to lithium augmentation based on the simplicity of dosing and a lower risk of injurious falls. 1b-

Study design: Randomized controlled trial (nonblinded)

Funding: Government

Setting: Outpatient (any)

Reviewer

Mark H. Ebell, MD, MS
Professor
University of Georgia
Athens, GA


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Comments

ARUP KUMAR DHARA

Impact assessment

Very good

Anonymous

Not a slam at the reviewer…

Not a slam at the reviewer from Georgia, but the note regarding pricing (clearly coming from the US) is not as helpful to a CMA audience. Would have been helpful to have Canadian data for this part of the review.

Anonymous

It would be nice to know what the patients were taking befor

THis could be relevant in the choice of augmenting agent.

Anonymous

resistant depression over age 60

adding adjuvants ie apiprazole, can help