Wednesday, June 27, 2018

Depression Severity May Predict Akathisia Risk With Aripiprazole Augmentation in Older Adults

Adding the antipsychotic aripiprazole to an antidepressant regimen can benefit older patients with treatment-resistant depression, but the strategy comes with risks: aripiprazole augmentation can cause extrapyramidal symptoms, such as akathisia and parkinsonism, according to a study in the Journal of Clinical Psychiatry. Thus, clinicians need to pay close attention when prescribing aripiprazole to older patients with more severe depressive symptoms.

Jonathan H. Hsu, M.D., of the University of Toronto, and colleagues analyzed data collected during a randomized, controlled trial evaluating the efficacy and safety of aripiprazole augmentation for adults aged older than 60 years with treatment-resistant depression. Patients who did not achieve remission after receiving venlafaxine extended-release (up to 300 mg/day) for 12 weeks were randomly assigned to receive aripiprazole augmentation (maximum dose 15 mg/day) or placebo for 12 weeks. Throughout the trial, the researchers assessed patients for extrapyramidal symptoms.

Forty (44%) of the 91 participants randomly assigned to aripiprazole achieved remission compared with 26 (29%) of 90 randomly assigned to placebo—a significant difference. Akathisia was the most common adverse effect of aripiprazole; 24 (26.7%) developed akathisia compared with 11 (12.2%) of participants assigned to placebo. Those who developed akathisia had higher depression severity at baseline. Aripiprazole was also associated with more parkinsonism; 15 people in the aripiprazole group (16.5%) developed parkinsonism compared with 2 (2.2%) in the placebo group. No clinical predictors or correlates for parkinsonism were identified. The researchers noted that most participants who developed akathisia improved over time, especially when aripiprazole dose was lowered.

“Fortunately, most older depressed patients who are prescribed aripiprazole will not develop akathisia, yet the emergence of these symptoms should be assessed carefully, particularly during initial dosage titration,” Hsu and colleagues concluded.

For related information, see The American Psychiatric Association Publishing Textbook of Psychopharmacology.

(Image: iStock/fzant)


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