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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by SLS on October 8, 2009, at 10:11:36
Effectiveness study of venlafaxine-XR combined with aripiprazole for chronic or recurrent major depressive disorder:
http://www.informaworld.com/smpp/content~content=a915575415~db=all~jumptype=rss
Authors: Andrew A. Nierenberg a; Madhukar H. Trivedi b; Bradley N. Gaynes c; Jeff Mitchell de; Lori L. Davis f; Mustafa M. Husain b; Stephen R. Wisniewski g; Maurizio Fava a; Diane Warden b; James F. Luther g; Adrienne O. van Nieuwenhuizen a; David W. Morris b; Richard C. Shelton h; A. John Rush b
Affiliations: a Harvard Medical School, Depression Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA
b Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
c University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
d University of Oklahoma College of Medicine, Tulsa
e Laureate Psychiatric Clinic and Hospital, Tulsa, Oklahoma, USA
f School of Medicine, University of Alabama; VA Medical Center, Tuscaloosa, Alabama, USA
g Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
h Vanderbilt University, Nashville, Tennessee, USA
Abstract:Objective: Although the second-generation antipsychotic, aripiprazole (ARI), has been approved as an adjunct for treatment-resistant major depressive disorder (MDD), neither ARI nor any second-generation antipsychotic has been assessed in combination with an antidepressant at the initiation of a treatment trial for non-treatment-resistant MDD. The aim of the present study was therefore to assess the safety, tolerability, and remission rate in the treatment of MDD using the specific combination of venlafaxine-XR (VEN-XR) and ARI in a generalizable, difficult-to-treat group with chronic or recurrent MDD.
Methods: Self-declared participants in primary care or psychiatric settings who had chronic or recurrent MDD and a minimum score of 14 on the 17-item Hamilton Rating Scale for Depression were included. Up to 12 weeks of open treatment with the combination of VEN-XR and ARI was provided. Participants began with VEN-XR, and ARI was added at week 2. Maximum allowable doses were 300 mg day-1 for venlafaxine-XR and 30 mg day-1 for ARI. Remission was defined as ≤ 5 on the 16-item Quick Inventory of Depressive Symptomatology-Self-report (QIDS-SR16).
Results: Fifty outpatients with non-psychotic MDD were enrolled (mean age = 43±11 years; 38% male; QIDS-SR16=15±3). Mean exit dose of VEN-XR was 227±97 mg day-1, and the mean exit dose of ARI was 11±7 mg day-1. The combination was well tolerated; 16% of participants discontinued due to side-effects. Approximately 70% achieved remission at some point during the trial, and 66% achieved remission at study exit.
Conclusions: To the best of the authors' knowledge this is the first study to combine an antidepressant and second-generation antipsychotic at the beginning of a treatment trial for chronic or recurrent non-treatment resistant MDD. VEN-XR and ARI combination appears to warrant further study in controlled trials.
- Scott
Posted by Phillipa on October 8, 2009, at 12:09:38
In reply to Effexor + Abilify for TRD - Recent Harvard study., posted by SLS on October 8, 2009, at 10:11:36
Scott just men? And why did they start the doses of both meds so high? Phillipa
Posted by Bob on October 8, 2009, at 17:43:54
In reply to Effexor + Abilify for TRD - Recent Harvard study., posted by SLS on October 8, 2009, at 10:11:36
Scott:
Am I missing something? It looks like that study was for non-TRD subjects, rather than TRD.
Bob
Posted by SLS on October 8, 2009, at 22:40:51
In reply to Re: Effexor + Abilify for TRD - Recent Harvard study. » SLS, posted by Bob on October 8, 2009, at 17:43:54
> Scott:
>
> Am I missing something? It looks like that study was for non-TRD subjects, rather than TRD.
>
> Bob
No. You are right. I misread the study. Thanks.It is an interesting idea to start someone off with the Effexor + Abilify combination as a first-line treatment if they present with a chronic or recurrent depression.
- Scott
Posted by SLS on October 8, 2009, at 22:44:38
In reply to Re: Effexor + Abilify for TRD - Recent Harvard study. » SLS, posted by Phillipa on October 8, 2009, at 12:09:38
> Scott just men? And why did they start the doses of both meds so high? Phillipa
I imagine they wanted to use the higher end of the dosage ranges to give their patients the best chance of responding quickly.
- Scott
Posted by sowhysosad on October 9, 2009, at 13:23:44
In reply to Oops. Good catch. Not TRD. » Bob, posted by SLS on October 8, 2009, at 22:40:51
> > Scott:
> >
> > Am I missing something? It looks like that study was for non-TRD subjects, rather than TRD.
> >
> > Bob
>
>
> No. You are right. I misread the study. Thanks.
>
> It is an interesting idea to start someone off with the Effexor + Abilify combination as a first-line treatment if they present with a chronic or recurrent depression.
>
>
> - ScottThe NICE guidelines here in the UK have this to say about AP augmentation in TRD:
"There is little evidence on which to make an evidence-based recommendation of
antipsychotic augmentation of antidepressants for the treatment of treatment-resistant
depression."I believe some forward-thinking pdocs occasionally augment with an AP but normally they're reserved for psychotic depression here.
This is the end of the thread.
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