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The VA augmentation and switching treatments for improving depression outcomes (VAST-D) study: Rationale and design
Somaia Mohamed1, Gary R Johnson2, Julia E Vertrees3
1VA VISN 1 New England Mental Illness Research,Education and Clinical Center, Veterans Health Administration, West Haven, CT and Yale University School of Medicine, 950 Campbell Ave., West Haven, CT 06516, USA.
Psychiatry Research
|August 18, 2015
Summary
Many patients with Major Depressive Disorder do not respond to initial treatment. This study compares switching antidepressants versus augmentation strategies for improved remission and relapse prevention in Major Depressive Disorder.
Area of Science:
- Psychiatry
- Clinical Psychology
- Pharmacology
Background:
- Two-thirds of Major Depressive Disorder patients lack remission with initial antidepressant therapy.
- Identifying effective next-step treatment strategies is crucial for managing treatment-resistant depression.
- Current treatment guidelines offer limited evidence for optimal sequential or augmentation approaches.
Purpose of the Study:
- To compare the efficacy of three next-step treatment strategies for Major Depressive Disorder.
- To evaluate 12-week remission rates for switching to bupropion-SR, augmenting with bupropion-SR, or augmenting with aripiprazole.
- To assess relapse rates up to 6 months post-treatment in patients achieving partial response.
Main Methods:
- A mixed efficacy-effectiveness trial design was employed.
- Participants not achieving remission with their first antidepressant were randomized to one of three strategies.
- Remission rates at 12 weeks and relapse rates over 6 months were primary outcomes.
Main Results:
- The study is designed to compare remission and relapse rates between the different next-step strategies.
- Specific quantitative results are pending completion of the trial.
- The design addresses key decisions in balancing efficacy and effectiveness in clinical trials.
Conclusions:
- The trial will provide critical data on optimal next-step treatments for Major Depressive Disorder.
- Findings will inform clinical practice for patients with treatment-resistant depression.
- This research addresses a significant gap in evidence-based treatment algorithms.
