Wednesday, September 30, 2015

Combining Aripiprazole, Venlafaxine Reduces Depressive Symptoms in Older Adults

Adding a low dose of the antipsychotic aripiprazole to the antidepressant regimen of older adults with treatment-resistant depression may help them achieve and sustain remission, according to a study published yesterday in the Lancet.

Previous studies show that more than half of older adults with major depressive disorder fail to respond to selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). In the current study, Charles Reynolds, M.D. (pictured left), a professor of geriatric psychiatry at the University of Pittsburgh School of Medicine, and his colleagues tested the effectiveness and safety of aripiprazole as an adjunctive therapy to venlafaxine in 468 adults aged 60 and over with no history of cognitive deficits.

Each study participant received an extended-release formulation of venlafaxine—ranging from 150 mg per day to 300 mg per day—for 12 weeks. Of the 181 patients whose symptoms did not remit after 12 weeks of treatment, 91 were randomly assigned to receive venlafaxine for another 12 weeks with the addition of 10 mg to 15 mg of aripiprazole and 90 received placebo in addition to venlafaxine each day. Remission was defined as a Montgomery Asberg Depression Rating Scale score of 10 or less (and at least 2 points below the score at the start of the randomized phase) at both of the final two consecutive visits.

The results showed that combined venlafaxine and aripiprazole therapy led to remission of depressive symptoms in 44% of treatment-resistant patients compared with 29% of participants who received venlafaxine and placebo.

Akathisia and Parkinsonism were the most common adverse events reported by participants in the aripiprazole adjunctive therapy group, occurring respectively in 26% and 17% of those patients. No differences were reported between groups in changes in percentage of body fat, or in total cholesterol, HDL, LDL, triglycerides, glucose, or insulin concentrations.

“Our results showed that aripiprazole is moderately effective in older adults with treatment-resistant depression,” the authors wrote. “Clinicians prescribing this medication should be aware of its propensity to cause akathisia and Parkinsonism. However, the potential benefits of remission from depression and greater reductions in suicidal ideation outweigh these usually mild adverse events.”

To read more about treating older adults with depression, see the Psychiatric News article “Older Adults Are More Likely to Receive Prescriptions for Depression, Anxiety.”

Human Rights Expert to Be Keynote Speaker at APA’s Meeting in NYC

Adeyinka M. Akinsulure-Smith, Ph.D., is a licensed psychologist from Sierra Leone who has participated in human rights investigations in Sierra Leone, worked with war victims from the African diaspora and survivors of torture, and served as an expert on gender crimes and posttraumatic stress disorder in a case before the International Criminal Court. She will discuss her work and experiences on Thursday, October 8, at IPS:The Mental Health Services Conference, which is being held at the Sheraton New York Times Square Hotel. Learn more about the meeting and register now.

(Top image courtesy of University of Pittsburgh School of Medicine)


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