Augmentation treatment in major depressive disorder: focus on aripiprazole

Figures & data

Figure 1 Remission is the key stepping stone between response to an acute episode and achieving full recovery (After Kupfer 1991).

Figure 2 Remission at entry into follow-up was associated with lower relapse rates than response without remission in STAR*D study (12-month follow-up period) (After Rush et al 2006).

Relapse = QIDS-SR score ≥ 11.

Figure 3 Meta-analysis of studies of atypical antipsychotic augmentation of antidepressants. Papakostas GI, Shelton RC, Smith J, et al 2007a. Augmentation of antidepressants with atypical antipsychotic medications for treatment-resistant major depressive disorder: a meta-analysis. J Clin Psychiatry, 68:826–31. Copyright © 2007 Physicians Postgraduate Press. Reprinted with permission.

Table 1 Overview of clinical data for aripiprazole in major depressive disorder

Study	Aripiprazole starting dose (permitted adjustment), mg	Comparator	Duration	Total n	Primary endpoint	Primary publication
CN138–139	5 (2–20)	Placebo	6 weeks	362	Mean change in MADRS from baseline to Week 6: −8.8 vs −5.8, p < 0.001	Berman et al 2007
CN138–163	5 (2–20)	Placebo	6 weeks	381	Mean change in MADRS from baseline to Week 6: −8.5 vs −5.7, p = 0.001	Marcus et al 2008
CN138–462	10 (10–20)	N/A	15 days	38	No meaningful effects on the pharmacokinetic parameters for venlafaxine (Cmax, Cmin, Tmax, AUC(TAU)) when administered alone and co-administered with aripiprazole	Boulton et al in press
CN138–463	10 (no adjustment)	N/A	15 days	25	No meaningful effects on the pharmacokinetic parameters for escitalopram (Cmax, Cmin, Tmax, AUC(TAU)) when administered alone and co-administered with aripiprazole	Boulton et al in press
CN138–164	Continuation dose from Studies CN138–139 and CN138–163	Placebo	52 weeks	930	Incidence of treatment-emergent adverse events	Berman et al 2008
CN138–165	5 (2–20)	Placebo	6 weeks	349	Incidence of treatment-emergent adverse events	Unpublished data

Figure 4 Change from baseline in MADRS Total score (last observation carried forward) in the two randomized, double-blind, placebo-controlled studies of adjunctive aripiprazole.

**p < 0.01 vs placebo.

***p < 0.001 vs placebo; MADRS Total score is rated from 0 to 60, where a negative change indicates improvement.

Abbreviations: MADRS, Montgomery – Asberg Depression Rating Scale; LOCF, last observation carried forward.

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BermanRFavaMBakerRA2007aMetabolic effects of aripiprazole adjunctive therapy in major depressive disorder subpopulations (Studies CN138–139 and CN138–163)Presented at the Annual Meeting of American College of NeuropsychopharmacologyBoca Raton, Florida, USA

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