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Published Online, 20 May 2008, www.theannals.com, DOI 10.1345/aph.1K630.
 The Annals of Pharmacotherapy: Vol. 42, No. 7, pp. 1124-1129. DOI 10.1345/aph.1K630
© 2008 Harvey Whitney Books Company.
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Adjunctive Aripiprazole for Bupropion-Resistant Major Depression

Kenneth N Sokolski, MD

Associate Adjunct Professor, Department of Psychiatry and Human Behavior, University of California, Irvine; Chief of Mood Disorder Clinic and Staff Psychiatrist, Veterans Affairs Long Beach Healthcare System, Long Beach, CA

Reprints: Dr. Sokolski, VA Long Beach Healthcare System, 5901 E. 7th St., Long Beach, CA 90822, fax 562/826-5088, kksokolski{at}aol.com

OBJECTIVE: To examine the effects of adjunctive aripiprazole in patients with major depression refractory to adequate therapy with bupropion.

CASE SUMMARY: Four consecutive patients diagnosed with major depression that was not responsive to a minimum of 2 months of therapy with bupropion 150–450 mg/day were given adjunctive aripiprazole 2.5–10 mg/day and followed for at least 4 months. Chart notes were used to record patient responses. All patients reported rapid improvement in depressive symptoms following the addition of low-dose aripiprazole. Antidepressant effects were sustained for at least 4 months in all patients; however, the mood disturbance subsequently returned in 2 patients. Adjunctive aripiprazole was well tolerated, with one patient developing akathisia that responded to lowering the aripiprazole dose and another exhibiting worsening of preexisting insomnia. Weight and metabolic parameters were not monitored during the observation period.

DISCUSSION: Transitory improvements in depressive symptoms that occurred in some of the 4 patients may have been due to compensatory mechanisms in dopaminergic systems. Adjunctive use of the atypical antipsychotic aripiprazole has been demonstrated to benefit depressed patients who are resistant to selective serotonin-reuptake inhibitors. The response to aripiprazole in patients refractory to bupropion has not been previously reported.

CONCLUSIONS: Adjunctive aripiprazole given in low doses resulted in rapid improvements in depressed patients who were refractory to adequate therapy with bupropion. Additional studies are required to determine whether these results can be generalized to other depressed individuals who are refractory to bupropion treatment.

Key Words: aripiprazole, bupropion, depression

Published Online, May 20, 2008. www.theannals.com, DOI 10.1345/aph.1K630




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