Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna,Austria.
Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna,Italy.
Int J Neuropsychopharmacol. 2022 Feb 11;25(2):118-127. doi: 10.1093/ijnp/pyab066.
Augmentation with second-generation antipsychotics (SGAs) represents an evidence-based psychopharmacotherapeutic strategy recommended in case of insufficient response to the first-line antidepressant (AD) treatment in major depressive disorder (MDD). Comparative evidence regarding efficacy and prescription preferences of the individual SGAs is scarce.
In the scope of this European, multi-site, naturalistic cross-sectional investigation with retrospective assessment of treatment outcome, we compared sociodemographic and clinical characteristics of 187 MDD patients receiving either quetiapine (n = 150) or aripiprazole (n = 37) as augmentation of their first-line AD psychopharmacotherapy.
Comorbid posttraumatic stress disorder and diabetes were significantly associated with aripiprazole augmentation in our primary and post-hoc binary logistic regression analyses. Furthermore, we identified an association between aripiprazole co-administration and the presence of additional psychotic features, higher rates of AD combination treatment, and a longer duration of psychiatric hospitalizations during the lifetime, which, however, lost significance after correcting for multiple comparisons. Regarding treatment outcome, we found a trend of higher response rates and greater reductions in severity of depressive symptoms in MDD patients dispensed quetiapine.
Factors associated with a more chronic and severe profile of MDD seem to encourage clinicians to choose aripiprazole over quetiapine, that was, however, administered in the majority of our MDD patients, which might reflect the current approval situation allowing to prescribe exclusively quetiapine as on-label augmentation in MDD in Europe. Given the retrospective assessment of treatment response, the markedly smaller proportion of patients receiving aripiprazole augmentation generally showing an unfavorable disease profile, and the partially heterogeneous statistical robustness of our findings, further studies are required to elaborate on our observation and to generate unambiguous recommendations regarding the choice of first-line SGA augmentation in MDD.
在重度抑郁症（MDD）中，如果一线抗抑郁药（AD）治疗反应不足，第二代抗精神病药（SGAs）的增效治疗代表了一种基于证据的精神药理学治疗策略。关于个别 SGA 的疗效和处方偏好的比较证据很少。
在这项欧洲多地点、自然主义的回顾性治疗结果横断面调查中，我们比较了 187 名 MDD 患者的社会人口统计学和临床特征，这些患者接受了喹硫平（n=150）或阿立哌唑（n=37）作为一线 AD 精神药理学治疗的增效治疗。
在我们的主要和事后二元逻辑回归分析中，创伤后应激障碍和糖尿病共病与阿立哌唑增效显著相关。此外，我们发现阿立哌唑联合用药与存在其他精神病特征、AD 联合治疗率较高以及一生中精神科住院时间较长有关，但在进行多次比较校正后，这种关联失去了意义。关于治疗结果，我们发现服用喹硫平的 MDD 患者的反应率较高，抑郁症状严重程度的降低幅度较大。
与 MDD 更慢性和更严重特征相关的因素似乎促使临床医生选择阿立哌唑而不是喹硫平，然而，在我们的大多数 MDD 患者中，喹硫平被开处方，这可能反映了目前的批准情况，即在欧洲仅允许将喹硫平作为标签外的增效治疗 MDD。鉴于治疗反应的回顾性评估，接受阿立哌唑增效治疗的患者比例明显较小，一般表现出不利的疾病特征，以及我们发现的部分统计稳健性存在差异，需要进一步研究来详细阐述我们的观察结果，并就 MDD 中一线 SGA 增效治疗的选择提出明确的建议。
