Augmentation strategies can be used to optimize response in patients with major depressive disorder (MDD) who have not responded adequately to antidepressant monotherapy; however, we have no data on the use of adjunctive treatments in women with postpartum depression (PPD). A recent study tested the effectiveness of antidepressant augmentation with aripiprazole (Abilify) in a cohort of 10 women with onset of a depression within 3 months of the birth of a healthy, close-to-term baby.
The open-label study included 10 women who had failed to respond adequately to treatment with antidepressant. Aripiprazole was added to the antidepressant at 2 mg/day at the second visit and increased weekly in 1- to 2-mg increments as needed to a maximum of 10 mg/day.
Eight of ten women completed the trial. Six of the women (75%) experienced remission, defined as a MADRS score of less than 10. Seven of the women (88 %) showed a positive response, defined as having 50% or greater reduction in MADRS score. Aripiprazole was well tolerated; patients reported mild side effects such as sleeplessness (n=3), headaches (n=2), and nausea (n=2). There were no switches to hypomania or mania during treatment with aripiprazole. All participants remaining in the study at week 8 were receiving a dose of 2 mg aripiprazole at their final visit.
While this is a very small study and needs to be replicated in a larger sample, the results are promising. The response and remission rates observed in this study were higher than those observed in open-label studies of antidepressants for PPD. In addition, the women responded to low doses of aripiprazole and experienced no serious side effects.
Ruta Nonacs, MD PhD
Sharma V, Sommerdyk C, Xie B. Aripiprazole augmentation of antidepressants for postpartum depression: a preliminary report. Arch Womens Ment Health. 2014 Sep 17. [Epub ahead of print]