Effect of Antidepressant Switching vs Augmentation on Remission Among Patients With Major Depressive Disorder Unresponsive to Antidepressant Treatment

作者：Somaia Mohamed, Gary R. Johnson, Peijun Chen, Paul B. Hicks, Lori L. Davis, Jean Yoon, Theresa Gleason, Julia E. Vertrees, Kimberly Weingart, Ilanit Tal, Alexandra Scrymgeour, David Lawrence, Beata Planeta, Michael E. Thase, Grant D. Huang, Sidney Zisook, and the VAST-D Investigators, Sanjai Rao, Patricia Pilkinton, James A. Wilcox, Ali Iranmanesh, Mamta Sapra, George Jurjus, James P. Michalets, Muhammed Aslam, Thomas P. Beresford, Keith D. Anderson, Ronald Fernando, Sriram Ramaswamy, John Kasckow, Joseph Westermeyer, Gihyun Yoon, Deepak Cyril D’Souza, Gunnar Larson, W. Gary Anderson, Mary M. Klatt, Ayman Fareed, Shabnam I. Thompson, Carlos J. Carrera, Solomon S. Williams, Timothy Juergens, Lawrence J. Albers, Clifford S. Nasdahl, Gerardo Villarreal, Julia L. Winston, Cristobal A. Nogues, K. Ryan Connolly, André Tapp, Kari Jones, Gauri Khatkhate, Sheetal Marri, Trisha Suppes, Joseph M. LaMotte, Robin A. Hurley, Aimee R. Mayeda, Alexander B. Niculescu, Bernard A. Fischer, David Loreck, Nicholas Rosenlicht, Steven P. Lieske, Mitchell S. Finkel, John T. Little · 发表于：JAMA · 年份：2017 · DOI：10.1001/jama.2017.8036 · 被引用次数：155 · 研究领域：Treatment of Major Depression、Mental Health Treatment and Access、Digital Mental Health Interventions

IMPORTANCE: Less than one-third of patients with major depressive disorder (MDD) achieve remission with their first antidepressant. OBJECTIVE: To determine the relative effectiveness and safety of 3 common alternate treatments for MDD. DESIGN, SETTING, AND PARTICIPANTS: From December 2012 to May 2015, 1522 patients at 35 US Veterans Health Administration medical centers who were diagnosed with nonpsychotic MDD, unresponsive to at least 1 antidepressant course meeting minimal standards for treatment dose and duration, participated in the study. Patients were randomly assigned (1:1:1) to 1 of 3 treatments and evaluated for up to 36 weeks. INTERVENTIONS: Switch to a different antidepressant, bupropion (switch group, n = 511); augment current treatment with bupropion (augment-bupropion group, n = 506); or augment with an atypical antipsychotic, aripiprazole (augment-aripiprazole group, n = 505) for 12 weeks (acute treatment phase) and up to 36 weeks for longer-term follow-up (continuation phase). MAIN OUTCOMES AND MEASURES: The primary outcome was remission during the acute treatment phase (16-item Quick Inventory of Depressive Symptomatology-Clinician Rated [QIDS-C16] score ≤5 at 2 consecutive visits). Secondary outcomes included response (≥50% reduction in QIDS-C16 score or improvement on the Clinical Global Impression Improvement scale), relapse, and adverse effects. RESULTS: Among 1522 randomized patients (mean age, 54.4 years; men, 1296 [85.2%]), 1137 (74.7%) completed the a...