Trial reportThe New England journal of medicine2023
Antidepressant Augmentation versus Switch in Treatment-Resistant Geriatric Depression.
Registry-linked trialOpen access · greenAbstract readComparative StudyRandomized Controlled Trial
In one paragraph
Trial report in The New England journal of medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02960763 (Optimizing Outcomes of Treatment-Resistant Depression in Older Adults), which is not on this map. Cited by 30 papers, 2 of them syntheses that pooled it.
0numbers the graph read from it
0cells of the map it votes in
30citing papers in PubMed, 2 pooled it
16.5field-weighted citation impact, top 1% of its field
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Optimizing Outcomes of Treatment-Resistant Depression in Older Adults
Who cites it
30 citing papers in PubMed, 2 syntheses or guidelines pooled it, 69 citations in OpenAlex.
- Rethinking Treatment-Resistant Depression: A Systematic Review of Novel Therapeutic Strategies and Precision Medicine Approaches.Actas espanolas de psiquiatria · 2025Pooled it
- Pooled it
- Electroencephalographic Biomarkers of Deep Transcranial Magnetic Stimulation Treatment Response for Major Depressive Disorder in Older Adults: A Preliminary Study.International journal of geriatric psychiatry · 2026Trial
- Effects of open-label transdermal nicotine antidepressant augmentation on affective symptoms and executive function in late-life depression.Journal of affective disorders · 2024Trial
- Relationship between Patient Health Questionnaire (PHQ-9) and Montgomery-Asberg Depression Rating Scale (MADRS) total scores in older adults with major depressive disorder: An analysis of the OPTIMUM clinical trial.Journal of affective disorders · 2024Trial
- Brain-cognition relationships and treatment outcome in treatment-resistant late-life depression.Nature communications · 2026Article
- Second-Generation Antipsychotics for Depression in Serious Illness: A First-Line Augmentation Strategy.Journal of pain and symptom management · 2026Review
- Molecular and neural circuit mechanisms of parvalbumin (PV) neurons in depression: Insights and advances.iScience · 2026Review
- Article
- Optimizing antidepressant use in geriatric depression: expert consensus from French societies of geriatrics, old age psychiatry, and clinical pharmacy (SFGG, SF3PA, and SFPC).European psychiatry : the journal of the Association of European Psychiatrists · 2026Article
- Pharmacotherapy of major depressive disorder in older adults: from an evidence-informed stepwise algorithm to precision medicine.Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology · 2026Review
- Moderators of treatment response in late-life depression.Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology · 2026Review
- Next-Step Treatment Options for Treatment-Resistant Depression: Insights From the Mayo Clinic Depression Center Panel.The Journal of clinical psychiatry · 2026Article
- Next-Generation Pharmacotherapy for Depressive Disorders: From Novel Compounds to Optimized Use of Available Drugs.Drug design, development and therapy · 2026Review
- Aripiprazole or Bupropion Augmentation Versus Switching to Bupropion in Treatment-Resistant Depression: A Risk-Benefit Analysis.The Journal of clinical psychiatry · 2025Article
- Everyday functioning in treatment-resistant late-life depression: The mediating role of cognition.Journal of the International Neuropsychological Society : JINS · 2025Article
- Classic Psychedelics for the Treatment of Depression: Potential Benefits and Challenges.Drugs · 2025Review
- Cognitive Deficits in Late-Life Depression: From Symptoms and Assessment to Therapeutics.Focus (American Psychiatric Publishing) · 2025Review
- EBM BLS: In Older Patients with Treatment-Resistant Depression, Adding Aripiprazole to Current Antidepressant Increased Psychological Well-Being and Depression Remission Rates.Journal of general internal medicine · 2025Article
- Comparison of the efficacy and safety of bupropion versus aripiprazole augmentation in adults with treatment-resistant depression: a nationwide cohort study in South Korea.European psychiatry : the journal of the Association of European Psychiatrists · 2025Article
Corrections and comments
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Authors and funding
19 authors at 7 institutions in 3 countries.
Eric J LenzeFrom the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.).
Benoit H MulsantFrom the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.).
Steven P RooseFrom the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.).
Helen LavretskyFrom the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.).
Charles F ReynoldsFrom the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.).
Daniel M BlumbergerFrom the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.).
Patrick J BrownFrom the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.).
Pilar CristanchoFrom the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.).
Alastair J FlintFrom the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.).
Marie A GebaraFrom the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.).
Torie R GettingerFrom the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.).
Emily LenardFrom the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.).
J Philip MillerFrom the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.).
Ginger E NicolFrom the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.).
Hanadi A OughliFrom the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.).
Vy T PhamFrom the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.).
Bruce L RollmanFrom the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.).
Lei YangFrom the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.).
Jordan F KarpFrom the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.).
Washington University in St. Louis · USUniversity of Pittsburgh · USCentre for Addiction and Mental Health · CANeurobehavioral Systems · USNew York State Psychiatric InstituteCentre for Mental Health · GBUniversity of Arizona · US
Funding
WU INSTITUTE OF CLINICAL AND TRANSLATIONAL SCIENCESUL1TR002345 · NCATS · WASHINGTON UNIVERSITY · PI William G. Powderly · 2017 to 2026
$97.8MBrain connectivity and response to Tai Chi in geriatric depressionR01AT008383 · NCCIH · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI LAVRETSKY, HELEN · 2015 to 2019
$4.1M1/5 Neurocognitive and neuroimaging biomarkers: predicting progression towards dementia in patients with treatment-resistant late-life depressionR01MH114970 · NIMH · CENTRE FOR ADDICTION AND MENTAL HEALTH · PI VOINESKOS, ARISTOTLE NICHOLAS · 2017 to 2021
$2.0M2/5 Neurocognitive and neuroimaging biomarkers: predicting progression towards dementia in patients with treatment resistant late-life depression.R01MH114980 · NIMH · NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC · PI BROWN, PATRICK J, RUTHERFORD, BRET R · 2017 to 2021
$1.8M4/5 Neurocognitive and neuroimaging biomarkers: predicting progression towards dementia in late-life depressionR01MH114981 · NIMH · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI LAVRETSKY, HELEN, NARR, KATHERINE L · 2017 to 2021
$1.8MMentoring and Research in Translational Science of Integrative MedicineK24AT009198 · NCCIH · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI Helen Lavretsky · 2016 to 2026
$1.4MNCATS NIH HHS UL1 TR002345NCCIH NIH HHS K24 AT009198NCCIH NIH HHS R01 AT008383NIMH NIH HHS R01 MH114970NIMH NIH HHS R01 MH114980NIMH NIH HHS R01 MH114981Patient-Centered Outcomes Research Institute TRD-1511-33321
Abstract
backgroundThe benefits and risks of augmenting or switching antidepressants in older adults with treatment-resistant depression have not been extensively studied.
methodsWe conducted a two-step, open-label trial involving adults 60 years of age or older with treatment-resistant depression. In step 1, patients were randomly assigned in a 1:1:1 ratio to augmentation of existing antidepressant medication with aripiprazole, augmentation with bupropion, or a switch from existing antidepressant medication to bupropion. Patients who did not benefit from or were ineligible for step 1 were randomly assigned in step 2 in a 1:1 ratio to augmentation with lithium or a switch to nortriptyline. Each step lasted approximately 10 weeks. The primary outcome was the change from baseline in psychological well-being, assessed with the National Institutes of Health Toolbox Positive Affect and General Life Satisfaction subscales (population mean, 50; higher scores indicate greater well-being). A secondary outcome was remission of depression.
resultsIn step 1, a total of 619 patients were enrolled; 211 were assigned to aripiprazole augmentation, 206 to bupropion augmentation, and 202 to a switch to bupropion. Well-being scores improved by 4.83 points, 4.33 points, and 2.04 points, respectively. The difference between the aripiprazole-augmentation group and the switch-to-bupropion group was 2.79 points (95% CI, 0.56 to 5.02; P = 0.014, with a prespecified threshold P value of 0.017); the between-group differences were not significant for aripiprazole augmentation versus bupropion augmentation or for bupropion augmentation versus a switch to bupropion. Remission occurred in 28.9% of patients in the aripiprazole-augmentation group, 28.2% in the bupropion-augmentation group, and 19.3% in the switch-to-bupropion group. The rate of falls was highest with bupropion augmentation. In step 2, a total of 248 patients were enrolled; 127 were assigned to lithium augmentation and 121 to a switch to nortriptyline. Well-being scores improved by 3.17 points and 2.18 points, respectively (difference, 0.99; 95% CI, -1.92 to 3.91). Remission occurred in 18.9% of patients in the lithium-augmentation group and 21.5% in the switch-to-nortriptyline group; rates of falling were similar in the two groups.
conclusionsIn older adults with treatment-resistant depression, augmentation of existing antidepressants with aripiprazole improved well-being significantly more over 10 weeks than a switch to bupropion and was associated with a numerically higher incidence of remission. Among patients in whom augmentation or a switch to bupropion failed, changes in well-being and the occurrence of remission with lithium augmentation or a switch to nortriptyline were similar. (Funded by the Patient-Centered Outcomes Research Institute; OPTIMUM ClinicalTrials.gov number, NCT02960763.).
Indexed as
Antidepressive AgentsAripiprazoleBupropionLithium CompoundsNortriptylineTreatment SwitchingAgedDepressionDrug Therapy, CombinationHumansAntidepressive AgentsAripiprazoleBupropionLithium CompoundsNortriptyline
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NCT02960763ClinicalTrials.gov
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.