Augmentation Strategies for Patients with Partial Response to Antidepressants

Introduction to Augmentation Strategies

• The American College of Physicians recommends augmentation with aripiprazol as the most preferred strategy for patients with partial response to an antidepressant, over switching medications or augmenting with brexpiprazol 1

Augmentation with Aripiprazol

• Aripiprazol has demonstrated significant efficacy as an augmentation strategy in patients with inadequate response to antidepressants, with studies showing it can double remission rates compared to placebo 1
• The use of aripiprazol as an adjunctive therapy is supported by its efficacy and tolerability in low doses, with a mean dose of 6.9 mg/day 1

Metabolic Monitoring

• The Lancet Psychiatry guidelines recommend essential metabolic monitoring for patients on atypical antipsychotics, including weight, abdominal circumference, blood pressure, glucose, and lipid profile 2

Patient-Centered Decision Making

• The decision to treat should consider the side effect profile and patient preferences after clear explanation of risks and benefits, as recommended by The Lancet Psychiatry 3

Aripiprazole Augmentation in Treatment-Resistant Depression

Introduction to Aripiprazole Augmentation

• The American Psychiatric Association recommends considering aripiprazole augmentation after inadequate response to at least one antidepressant treatment at adequate dose for at least 4 weeks 4, 5

Clinical Evidence for Aripiprazole Augmentation

• No cited facts are available for this section

Augmentation Strategy

• No cited facts are available for this section

Special Considerations

• No cited facts are available for this section

Atypical Antipsychotics for Depression Augmentation

Critical Metabolic Monitoring Requirements

• Before initiating any atypical antipsychotic, obtain baseline measurements of BMI and waist circumference, blood pressure, fasting glucose or HbA1c, lipid profile, liver function tests, renal function, and complete blood count, as recommended by The Lancet Psychiatry 6
• Follow-up monitoring schedule includes weight, BMI, and blood pressure checks weekly for 6 weeks, then at 3 months, then annually, and fasting glucose recheck at 4 weeks, then at 3 months, then annually, as recommended by The Lancet Psychiatry 6
• All metabolic parameters should be comprehensively reassessed at 3 months and annually thereafter, according to The Lancet Psychiatry guidelines 6

Common Pitfalls to Avoid

• Do not neglect metabolic monitoring, as atypical antipsychotics carry significant cardiometabolic risks even at low doses, as emphasized by The Lancet Psychiatry 6