Study finds adding 2nd med helps treat depression

NEW HAVEN » Adding a second medication to treat depression is a better strategy than simply switching to a different drug, according to a Yale study of patients at 35 U.S. Veterans Health Administration medical centers.

There are 16 million Americans with major depression and less than one-third of them achieve complete relief of their symptoms, known as remission, after being prescribed one medication, according to a study by the National Institute of Mental Health commonly called STAR*D.

The Yale/VA study focused on the two-thirds of patients who failed to achieve remission on one anti-depressant. A total of 1,522 patients were enrolled in the study.

The patients were divided into three groups. In one, they were taken off their previous medication and given a second anti-depressant, bupropion (Wellbutrin). The second group was given an anti-psychotic drug, aripiprazole (Abilify) in addition to their anti-depressant. The third was given bupropion in addition to the first antidepressant, according to the lead author, Dr. Somaia Mohamed.

Mohamed is associate clinical professor of psychiatry at the Yale School of Medicine and of the VA Connecticut Healthcare System in West Haven.

“What we found was [adding] aripiprazole did better than switching to bupropion with regard to remission, which means no symptoms at all,” Mohamed said. The study found 28.9 percent of patients achieved remission when aripiprazole was given as a second medication, according to a Yale release.

When bupropion was added to the first anti-depressant, 27 percent were relieved of their symptoms.

However, switching from one anti-depressant to bupropion alone brought remission to only 22 percent of patients.

Mohamed said researchers also looked at the rate of response to the second medication, defined as a 50 percent reduction of symptoms. “For response, which is just decreasing the symptoms considerably, [adding] aripiprazole did better than switching to bupropion and it did better than adding bupropion,” she said.

Mohamed said the side effects of the two drugs differed. “Bupropion was associated with more anxiety and aripiprazole with weight gain,” she said.

“The study by Mohamed and colleagues is one of the very few definitive studies addressing this question” said Dr. John Krystal, chairman of the medical school’s Psychiatry Department, in a press release. “This study provides the type of detailed guidance that doctors need.”

The study was published today in the journal JAMA.