Antipsychotic Addition Treats Depression in Seniors

Adding an antipsychotic to an antidepressant regimen may relieve treatment-resistant depression in seniors.

A recent clinical trial tested aripiprazole (Abilify) augmentation in patients 60 ages and older with hard-to-treat depression.

Before the trial began, patients received 100 mg/day to 300 mg/day of venlafaxine extended-release (Effexor XR). Those who did not achieve depression remission after 12 weeks were selected to also receive either Abilify (10 mg/day to 15 mg/day) or placebo for 12 more weeks.

Pharmacists played a part in the study by dispensing the medication and keeping it blind to the patients, author Eric J. Lenze, MD, a psychiatry professor at the Washington University School of Medicine in St. Louis, told Pharmacy Times.

Dr. Lenze explained that pharmacists are an essential resource for patient education, especially among the senior population.

“Pharmacists are critical in terms of counseling older adults who are often on many medications and frequently unaware of what to expect from their medications in terms of side effects or when to expect a response,” Dr. Lenze said.

Trial enrollment took place between 2009 and 2014, and eligible patients totaled 468. After the pretrial treatment of Effexor XR, the 181 patients who did not achieve remission were randomly assigned to the intervention or control treatments.

The researchers sought to determine which patients achieved depression remission at 2 final, consecutive visits. They found a greater proportion of those receiving Abilify achieved remission (44%) compared with those taking placebo (29%).

The most common adverse effect was akathisia, which was reported in 26% of the 91 patients taking Abilify versus 1% of the 90 patients taking placebo. Those on the intervention treatment were also more likely to report more Parkinsonism (17% versus 2%).

However, fewer patients in the Abilify group experienced treatment-emergent suicidal ideation than those in the placebo group.

The researchers also found that Abilify was not linked with an increase in cardiometabolic risk, which may help clinicians weigh the risks and benefits of aripiprazole augmentation.

“In adults aged 60 years or older who do not achieve remission from depression with a first-line antidepressant, the addition of aripiprazole is effective in achieving and sustaining remission,” the researchers concluded.

Treatment-resistant major depression is both common and potentially life threatening among elderly patients in particular.

“It’s important to treat older adults for depression, especially given that adults with late-life depression are at an increased risk of developing dementia,” said study author Benoit H. Mulsant, MD, in a press release.

While previous research has shown success with Abilify augmentation to antidepressant treatment, this is the first study to show a similar effect among seniors.

The results were published in The Lancet.