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Antipsychotic may help combat drug-resistant depression

Adding aripiprazole as augmentation may help clinically depressed elderly patients not responding to first-line antidepressant medication, researchers have said.

The potential benefit of aripiprazole for treatment-resistant clinical depression in older adults outweighs the risks associated with side-effects, the study published in the Lancet concluded.

In the randomised, double-blind, placebo-controlled trial, akathisia was the most common adverse effect of aripiprazole, reported in 26% of patients on the drug, compared with 1% on placebo. Aripiprazole was also linked with more Parkinsonism compared with placebo, with 17% and 2% of patients experiencing symptoms, respectively.

But patients on aripiprazole were two times more likely to achieve remission of their depression, compared with placebo.

With little evidence investigating second-line options for resistant depression in later life, the authors concluded that the research helped ‘clarify’ the risk-benefit ratio of aripiprazole augmentation in treatment-resistant older adults.

Although they warned that GPs should be aware of aripiprazole’s ability to cause akathisia and Parkinsonism, they added that the potential benefits of remission from depression outweigh the ‘usually mild’ adverse events.

The report, by researchers at the Washington University School of Medicine in St Louis, Missouri, said: ’In adults aged 60 years or older who do not achieve remission from depression with a first-line antidepressant, the addition of aripiprazole is effective in achieving and sustaining remission. Tolerability concerns include the potential for akathisia and Parkinsonism.’

Lancet, 2015; available online 27 Sep



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