PT. Otsuka Indonesia

The benefit of augmentation therapy in the management of major depressive disorder

The benefit of augmentation therapy in the management of major depressive disorder

Nonresponse to antidepressant therapy (ADT) is a common occurrence in clinical practice and a major public health challenge, with up to 60% of patients not achieving adequate response following antidepressant therapy.

A range of augmentation and combination strategies has been used in an attempt to improve outcomes in patients who show an inadequate antidepressant response or to increase the chance of achieving remission.
In particular, atypical antipsychotics are being increasingly used as adjunctive agents in clinical practice.

This study evaluated the efficacy and safety of adjunctive Abilify^_® or placebo to standard antidepressant therapy (ADT) in patients with major depressive disorder who showed an inadequate response to at least 1 and up to 3 historical and 1 additional prospective ADT. The study comprised a 7–28-day screening, an 8-week prospective treatment, and a 6-week randomization phase.

During prospective treatment, patients experiencing a major depressive episode (17-item Hamilton Rating Scale for Depression total score ) received single-blind adjunctive placebo plus clinicians’ choice of ADT (escitalopram, fluoxetine, paroxetine controlled-release, sertraline, or venlafaxine extended-release).
Subjects with inadequate response were randomized to adjunctive placebo or adjunctive Abilify^_® (starting dose 5 mg/d, dose adjustments 2–20 mg/d).

The primary efficacy endpoint was the mean change in Montgomery-Asberg Depression Rating Scale total score from end of prospective treatment phase to end of randomized treatment phase (last observation carried forward).

Mean change in Montgomery-Asberg Depression Rating Scale total score was significantly greater with adjunctive Abilify^_® than placebo. Remission rates were significantly greater with adjunctive Abilify^_® than placebo as were response rates.

Reference :

Fava M, Rush AJ. Current status of augmentation and combination treatments for major depressive disorder: a literature review and a proposal for a novel approach to improve practice. Psychother Psychosom.2006;75:139–153.

Ronald N. Marcus MD, Robert D. McQuade, PhD, William H. Carson. The Efficacy and Safety of Aripiprazole as AdjunctiveTherapy in Major Depressive DisorderA Second Multicenter, Randomized, Double-Blind, Placebo-Controlled Study.J Clin Psychopharmacol 2008;28:156–165

Jakarta, 28 Dec 2009

The benefit of augmentation therapy in the management of major depressive disorder