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Depressed patients sometimes are unresponsive to monotherapy with selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs). Two strategies to overcome unresponsiveness are switching to another drug class or adding a second drug from a different class (i.e., augmentation).
In this 10-week North American trial, 619 depressed older patients (age, >60) who were unresponsive to SSRIs or SNRIs were randomized to augmentation with the atypical antipsychotic aripiprazole, augmentation with bupropion, or switching to bupropion. Remission rates were significantly higher with augmentation (≈28% for both aripiprazole and bupropion) than with switching to bupropion (19%), and adherence was better with au…