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Impact of Concurrent Posttraumatic Stress Disorder on Outcomes of Antipsychotic Augmentation for Major Depressive Disorder With a Prior Failed Treatment: VAST-D Randomized Clinical Trial.
J Clin Psychiatry. 2020 Jun 23; 81(4)JC

Abstract

OBJECTIVE

To determine whether concurrent posttraumatic stress disorder (PTSD) should affect whether to augment or switch medications when major depressive disorder (MDD) has not responded to a prior antidepressant trial.

METHODS

Patients at 35 Veterans Health Administration medical centers from December 2012 to May 2015 with nonpsychotic MDD (N = 1,522) and a suboptimal response to adequate antidepressant treatment were randomly assigned to 3 "next step" treatments: switching to bupropion, augmenting the current antidepressant with bupropion, and augmenting with the antipsychotic aripiprazole. Blinded ratings with the 16-item Quick Inventory of Depressive Symptomatology-Clinician Rated (QIDS-C₁₆) determined remission and response by 12 weeks and relapse after remission. Survival analyses compared treatment effects in patients with concurrent PTSD diagnosed with the Mini-International Neuropsychiatric Interview (n = 717, 47.1%) and those without PTSD (n = 805, 52.9%).

RESULTS

Patients diagnosed with PTSD showed more severe depressive symptoms at baseline and were less likely to achieve either remission or response by 12 weeks. Augmentation with aripiprazole was associated with greater likelihood of achieving response (68.4%) than switching to bupropion (57.7%) in patients with PTSD (relative risk [RR] = 1.26; 95% CI, 1.01-1.59) as well as in patients without PTSD (RR = 1.29; 95% CI, 1.05-1.97) (78.9% response with aripiprazole augmentation vs 66.9% with switching to bupropion). Treatment comparisons with the group receiving augmentation with bupropion were not significant. There was no significant interaction between treatment group and PTSD on remission (P = .70), response (P = .98), or relapse (P = .15).

CONCLUSIONS

Although PTSD was associated with poorer overall outcomes, the presence of concurrent PTSD among Veterans in this trial did not affect the comparative effectiveness of medications on response, remission, or relapse after initial remission.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT01421342.

Authors+Show Affiliations

VA Connecticut Healthcare System, 950 Campbell Ave, Mailstop (182), West Haven, CT 06516. somaia.mohamed@va.gov. VA New England Mental Illness, Research, Education and Clinical Center, West Haven, Connecticut, USA.VA Connecticut Healthcare System, West Haven, Connecticut, USA.VA Connecticut Healthcare System, West Haven, Connecticut, USA. Yale University School of Public Health, New Haven, Connecticut, USA.VA San Diego Healthcare System, San Diego, California, USA.Baylor Scott and White Health, Temple, Texas, USA.Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA.VA San Diego Healthcare System, San Diego, California, USA.Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA.Tuscaloosa VA Medical Center, Tuscaloosa, Alabama, USA.Tuscaloosa VA Medical Center, Tuscaloosa, Alabama, USA.Tucson VA Medical Center, Tucson, Arizona, USA.Salem VA Medical Center, Salem, Virginia, USA.Salem VA Medical Center, Salem, Virginia, USA.Cincinnati VA Medical Center, Cincinatti, Ohio, USA.Charles George VA Medical Center, Asheville, North Carolina, USA.Philadelphia VA Medical Center, Philadelphia, Pennsylvania, USA.VA San Diego Healthcare System, San Diego, California, USA.The names of all participants in the VAST-D Study are listed in Supplementary Appendix 1.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32603560

Citation

Mohamed, Somaia, et al. "Impact of Concurrent Posttraumatic Stress Disorder On Outcomes of Antipsychotic Augmentation for Major Depressive Disorder With a Prior Failed Treatment: VAST-D Randomized Clinical Trial." The Journal of Clinical Psychiatry, vol. 81, no. 4, 2020.
Mohamed S, Johnson GR, Sevilimedu V, et al. Impact of Concurrent Posttraumatic Stress Disorder on Outcomes of Antipsychotic Augmentation for Major Depressive Disorder With a Prior Failed Treatment: VAST-D Randomized Clinical Trial. J Clin Psychiatry. 2020;81(4).
Mohamed, S., Johnson, G. R., Sevilimedu, V., Rao, S. D., Hicks, P. B., Chen, P., Lauro, K., Jurjus, G., Pilkinton, P., Davis, L., Wilcox, J. A., Iranmanesh, A., Sapra, M., Aslam, M., Michalets, J., Thase, M., & Zisook, S. (2020). Impact of Concurrent Posttraumatic Stress Disorder on Outcomes of Antipsychotic Augmentation for Major Depressive Disorder With a Prior Failed Treatment: VAST-D Randomized Clinical Trial. The Journal of Clinical Psychiatry, 81(4). https://doi.org/10.4088/JCP.19m13038
Mohamed S, et al. Impact of Concurrent Posttraumatic Stress Disorder On Outcomes of Antipsychotic Augmentation for Major Depressive Disorder With a Prior Failed Treatment: VAST-D Randomized Clinical Trial. J Clin Psychiatry. 2020 Jun 23;81(4) PubMed PMID: 32603560.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of Concurrent Posttraumatic Stress Disorder on Outcomes of Antipsychotic Augmentation for Major Depressive Disorder With a Prior Failed Treatment: VAST-D Randomized Clinical Trial. AU - Mohamed,Somaia, AU - Johnson,Gary R, AU - Sevilimedu,Varadan, AU - Rao,Sanjai D, AU - Hicks,Paul B, AU - Chen,Peijun, AU - Lauro,Kimberly, AU - Jurjus,George, AU - Pilkinton,Patricia, AU - Davis,Lori, AU - Wilcox,James A, AU - Iranmanesh,Ali, AU - Sapra,Mamta, AU - Aslam,Muhammad, AU - Michalets,James, AU - Thase,Michael, AU - Zisook,Sidney, AU - ,, Y1 - 2020/06/23/ PY - 2019/08/05/received PY - 2020/01/02/accepted PY - 2020/7/1/entrez PY - 2020/7/1/pubmed PY - 2020/7/1/medline JF - The Journal of clinical psychiatry JO - J Clin Psychiatry VL - 81 IS - 4 N2 - OBJECTIVE: To determine whether concurrent posttraumatic stress disorder (PTSD) should affect whether to augment or switch medications when major depressive disorder (MDD) has not responded to a prior antidepressant trial. METHODS: Patients at 35 Veterans Health Administration medical centers from December 2012 to May 2015 with nonpsychotic MDD (N = 1,522) and a suboptimal response to adequate antidepressant treatment were randomly assigned to 3 "next step" treatments: switching to bupropion, augmenting the current antidepressant with bupropion, and augmenting with the antipsychotic aripiprazole. Blinded ratings with the 16-item Quick Inventory of Depressive Symptomatology-Clinician Rated (QIDS-C₁₆) determined remission and response by 12 weeks and relapse after remission. Survival analyses compared treatment effects in patients with concurrent PTSD diagnosed with the Mini-International Neuropsychiatric Interview (n = 717, 47.1%) and those without PTSD (n = 805, 52.9%). RESULTS: Patients diagnosed with PTSD showed more severe depressive symptoms at baseline and were less likely to achieve either remission or response by 12 weeks. Augmentation with aripiprazole was associated with greater likelihood of achieving response (68.4%) than switching to bupropion (57.7%) in patients with PTSD (relative risk [RR] = 1.26; 95% CI, 1.01-1.59) as well as in patients without PTSD (RR = 1.29; 95% CI, 1.05-1.97) (78.9% response with aripiprazole augmentation vs 66.9% with switching to bupropion). Treatment comparisons with the group receiving augmentation with bupropion were not significant. There was no significant interaction between treatment group and PTSD on remission (P = .70), response (P = .98), or relapse (P = .15). CONCLUSIONS: Although PTSD was associated with poorer overall outcomes, the presence of concurrent PTSD among Veterans in this trial did not affect the comparative effectiveness of medications on response, remission, or relapse after initial remission. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01421342. SN - 1555-2101 UR - https://www.unboundmedicine.com/medline/citation/32603560/Impact_of_Concurrent_Posttraumatic_Stress_Disorder_on_Outcomes_of_Antipsychotic_Augmentation_for_Major_Depressive_Disorder_With_a_Prior_Failed_Treatment:_VAST-D_Randomized_Clinical_Trial L2 - http://www.psychiatrist.com/JCP/article/Pages/2020/v81/19m13038.aspx DB - PRIME DP - Unbound Medicine ER -
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