Abstract
Functional impairments are a common concern for individuals with major depressive disorder (MDD) that does not resolve with initial antidepressant treatment. Such concerns include cognitive difficulties, such as impaired executive functions, which can be particularly disruptive to daily function. There is a need to evaluate potential augmentation strategies for depressed individuals who do not adequately respond to initial antidepressant treatment. Aripiprazole is an FDA-approved adjunctive treatment to antidepressants for MDD, and because of its effect on both dopaminergic and serotonergic systems, may be of particular benefit to cognitive functioning. This study evaluated depressive symptom severity, cognitive function, and psychosocial function before and after six weeks of open-label aripiprazole augmentation treatment in patients with MDD who did not fully respond to selective serotonin reuptake inhibitor treatment. Participants endorsed difficulty with concentration and decision-making at study entry. Significant decreases were observed for depressive symptoms, and significant increases were found in executive function measures and measures of psychosocial function and quality of life. These preliminary data suggest that aripiprazole augmentation may yield functional benefits when used as an adjunctive treatment in MDD, and support the need for further investigation of aripiprazole and other augmentation strategies to specifically evaluate functional outcomes in MDD.
Highlights
Major depressive disorder (MDD) is a debilitating, chronic disorder that is of worldwide concern (Cuijpers et al, 2012), since it is estimated to become the most burdensome disease in high-income countries, and second-most overall, by the year 2030 (Mathers & Loncar, 2006)
The consensus of treatment guidelines for major depressive disorder is that the goal of treatment should be symptomatic remission, which is characterized by minimal absence of depressive symptoms (Davidson, 2010)
Because of the negative consequences of functional impairments, an alternative goal to symptomatic remission is achieving wellness (Keller, 2003; McIntyre et al, 2006), which incorporates restoration of function in addition to symptomatic and pathophysiologic change. To achieve such a goal, it is imperative that the field begins to include functional measures and targeted treatments for specific symptoms to improve the quality of life and functioning of depressed individuals (Greer et al, 2010)
Summary
Major depressive disorder (MDD) is a debilitating, chronic disorder that is of worldwide concern (Cuijpers et al, 2012), since it is estimated to become the most burdensome disease in high-income countries, and second-most overall, by the year 2030 (Mathers & Loncar, 2006). Because of the negative consequences of functional impairments, an alternative goal to symptomatic remission is achieving wellness (Keller, 2003; McIntyre et al, 2006), which incorporates restoration of function in addition to symptomatic and pathophysiologic change To achieve such a goal, it is imperative that the field begins to include functional measures and targeted treatments for specific symptoms to improve the quality of life and functioning of depressed individuals (Greer et al, 2010). This study was conducted to gather preliminary data for assessment of the following: 1) the effect of aripiprazole augmentation on depressive symptom severity, psychosocial function and cognitive function, and 2) the relationship between psychosocial function and cognitive function in MDD. We hypothesized that aripiprazole augmentation would be associated with reductions in symptom severity, and with improved performance on measures of psychosocial and cognitive function, measures of executive function
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