Staff and Researcher Publications

Language

English

Publication Date

8-1-2024

Journal

Molecular Psychiatry

DOI

10.1038/s41380-024-02468-x

PMID

38454079

PMCID

PMC11412904

PubMedCentral® Posted Date

5-7-2024

PubMedCentral® Full Text Version

Post-print

Abstract

Further research is needed to help improve both the standard of care and the outcome for patients with treatment-resistant depression. A particularly critical evidence gap exists with respect to whether pharmacological or non-pharmacological augmentation is superior to antidepressant switch, or vice-versa. The objective of this study was to compare the effectiveness of augmentation with aripiprazole or repetitive transcranial magnetic stimulation versus switching to the antidepressant venlafaxine XR (or duloxetine for those not eligible to receive venlafaxine) for treatment-resistant depression. In this multi-site, 8-week, randomized, open-label study, 278 subjects (196 females and 82 males, mean age 45.6 years (SD 15.3)) with treatment-resistant depression were assigned in a 1:1:1 fashion to treatment with either of these three interventions; 235 subjects completed the study. 260 randomized subjects with at least one post-baseline Montgomery-Asberg Depression Rating (MADRS) assessment were included in the analysis. Repetitive transcranial magnetic stimulation (score change (standard error (se)) = −17.39 (1.3) (p = 0.015) but not aripiprazole augmentation (score change (se) = −14.9 (1.1) (p = 0.069) was superior to switch (score change (se) = −13.22 (1.1)) on the MADRS. Aripiprazole (mean change (se) = −37.79 (2.9) (p = 0.003) but not repetitive transcranial magnetic stimulation augmentation (mean change (se) = −42.96 (3.6) (p = 0.031) was superior to switch (mean change (se) = −34.45 (3.0)) on the symptoms of depression questionnaire. Repetitive transcranial magnetic stimulation augmentation was shown to be more effective than switching antidepressants in treatment-resistant depression on the study primary measure. In light of these findings, clinicians should consider repetitive transcranial magnetic stimulation augmentation early-on for treatment-resistant depression.

Keywords

Humans, Male, Female, Middle Aged, Depressive Disorder, Treatment-Resistant, Venlafaxine Hydrochloride, Transcranial Magnetic Stimulation, Adult, Aripiprazole, Antidepressive Agents, Treatment Outcome, Duloxetine Hydrochloride, Comparative Effectiveness Research, Psychiatric Status Rating Scales, Combined Modality Therapy, Depression, Drug discovery

Comments

Trial registration: ClinicalTrials.gov, NCT02977299

Published Open-Access

yes

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