Aripiprazole versus Bupropion Augmentation in Patients with Anxious Depression Resistant to Selective Serotonin...

Research on which adjunctive therapies are more effective for treatment resistant anxious depression is lacking. This study aimed to evaluate and compare the efficacy and safety of bupropion versus aripiprazole as adjunctive therapies in patients with anxious depression who are resistant to selective serotonin reuptake inhibitors (SSRIs).

A total of 48 patients with anxious depression, defined as a score ≥ 7 on the anxiety/somatization factor of the Hamilton Depression Rating Scale (HAM-D), were enrolled in this 6-week, randomized, prospective, open-label, multicenter trial. Participants, having shown at least moderate to severe depressive symptoms despite four weeks or more of SSRI monotherapy at maximum recommended or tolerated doses, were randomized to receive either aripiprazole or bupropion.

Both treatment groups exhibited significant improvements in HAM-D and Montgomery-Åsberg Depression Rating Scale scores from baseline to week 6 (p < 0.001). There were no significant differences between the groups in the changes observed for Montgomery-Åsberg Depression Rating Scale scores (p = 0.370), HAM-D (p > 0.999), anxiety/somatization factor scores (p = 0.177), Inventory of Fatigue Scale (p = 0.600), Clinical Global Impression-Severity (p = 0.620), or the rates of remission (p = 0.130) and response (p = 0.452). Additionally, the Drug-Induced Extrapyramidal Symptoms Scale and Psychotropic-Related Sexual Dysfunction Questionnaire scores showed no significant differences.

Aripiprazole and bupropion are both effective and well-tolerated as augmentation strategies in SSRI-resistant anxious depression. While these findings provide clinical insights into individualized augmentation for anxious depression, they should be considered exploratory, necessitating larger-scale, definitive trials.