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Randomized Controlled Trial
. 2018 Feb;33(2):e330-e335.
doi: 10.1002/gps.4813. Epub 2017 Oct 3.

Specific depressive symptoms predict remission to aripiprazole augmentation in late-life treatment resistant depression

Affiliations
Randomized Controlled Trial

Specific depressive symptoms predict remission to aripiprazole augmentation in late-life treatment resistant depression

Marie Anne Gebara et al. Int J Geriatr Psychiatry. 2018 Feb.

Abstract

Objective: To identify which specific depressive symptoms predict remission to aripiprazole augmentation in late-life treatment resistant depression.

Methods: This is a secondary analysis of data from a late-life treatment resistant depression trial examining the safety and efficacy of aripiprazole augmentation. Participants aged 60 and above were randomized to aripiprazole augmentation (N = 91) versus placebo (N = 90). The main outcome was depression remission. Clinical predictors included individual Montgomery-Asberg Depression Rating Scale (MADRS) item scores categorized as symptomatic (scores >2) or nonsymptomatic (scores ≤2).

Results: Three MADRS items predicted depression remission with aripiprazole augmentation: symptomatic scores on sleep disturbance and nonsymptomatic scores on apparent sadness and inability to feel. The 2-way and 3-way interaction terms of these MADRS items were not significant predictors of remission; therefore, the models' ability to predict remission was not improved by combining the significant MADRS items.

Conclusions: The identification of specific depressive symptoms, which can be clinically assessed, can be used to inform treatment decisions. Older adults with treatment resistant depression that present with sleep disturbances, lack of apparent sadness, or lack of inability to feel should be considered for aripiprazole augmentation.

Keywords: MADRS; aging; aripiprazole; depression.

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Figures

Figure 1
Figure 1. Forest plot of the beta coefficients of MADRS items with corresponding confidence intervals and calculated odds ratio for significant items predicting remission with aripiprazole augmentation
Items to the left of the midline (zero) represent asymptomatic scores (0,1,2) and items to the right of the midline (zero) represent symptomatic scores (3 or more). When the lines cross 0, then the corresponding items are non-significant, and when the lines do not cross 0, then they are significant. Item 1 = apparent sadness, item 3 = inner tension, item 4 = reduced sleep, item 5 = reduced appetite, item 6 = concentration difficulties, item 7 = lassitude, item 8 = inability to feel, item 9 = pessimistic thoughts. * Calculated odds ratios for the beta coefficients of significant MADRS items: Item 1 (apparent sadness): β= −1.48, CI (−2.57 −.38); Item 4 (sleep disturbances): β = 1.65, CI (0.2412, 3.0566) ; item 8 (inability to feel) : β= −2.74, CI (−4.61 −.870).

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