Aripiprazole as an adjunctive treatment for refractory unipolar depression

Introduction: Aripiprazole may be an effective adjunctive treatment in outpatients with unipolar depression that has been refractory to treatment with SSRI or SNRI medication. Methods: Fifteen subjects with a current DSM-IV diagnosis of MDD which had not responded to SSRI or SNRI treatment were enrolled in a 12 week open-label study of aripiprazole with a maximum dose of 30 mg/day. Patients' current episode averaged 10.4 +/- 16.6 years, with a range of 3 months to 54 years. Baseline severity averaged 30.1 +/- 7.1 on HDRS-24, and 19.7 +/- 8.4 on BDI. Patients had been treated with a mean dose of 79.2 +/- 28.2 mg/day of fluoxetine equivalents for an average of 1 year prior to starting the study. Five subjects were on SNRI medications and 10 on SSRIs. Results: Seven of 14 (50.0%) subjects were classified as treatment responders, as defined by at least 50% reduction in the HDRS-24 at week 12. Four subjects (28.6%) achieved remission, based on STAR*D criteria (HDRS-17 score <= 7). 26.7% (4/15) of subjects discontinued participation due to side effects. Two (40%) of 5 SNRI-treated subjects responded to aripiprazole augmentation. Conclusions: These findings support previous studies for the effectiveness of aripiprazole in augmenting SSRIs or SNRIs in treatment-resistant major depression. (C) 2007 Elsevier Inc. All rights reserved.