New tack in treating major depressive disorder

Major depressive disorder or MDD is the fourth leading cause of disease burden worldwide, according to 2000 Global Burden of Disease Study.

It affects approximately 13 million to 14 million adults per year and is predicted that by the year 2020, MDD will be the leading cause of disability.

It is characterized by one or more major depressive episodes, often defined as period of daily and daylong depressed mood or loss of interest or pleasure in virtually all activities. There is absence of any history of manic, mixed or hypomanic episodes.

Otsuka (Philippines) Pharmaceutical Inc. (OPPI) sponsored a symposium during the recently concluded Philippine Psychiatric Association’s midyear convention.

The lecture symposium, entitled “Achieving Remission in Major Depressive Disorder: The Role of Atypical Antipsychotics,” discussed effective medical approaches in preventing and treating MDD.

Dr. Alma Jimenez, professor of psychiatry at the University of the Philippines’ College of Medicine, discussed ways to achieve remission focusing on the role of antipsychotics in the management of MDD.

Several augmentation or adjunctive strategies in treating MDD were mentioned. Among these are the atypical antipsychotics augmentation, which has demonstrated the clearest efficacy in the treatment of MDD.

The rationale for the use of this strategy is to improve the clinical efficacy of atypical antipsychotics by treating residual symptoms such as insomnia and to broaden the treatment’s neurochemical profile by obtaining complementary pharmacodynamic actions.

“Among those adjunctive atypical antipsychotics, only aripiprazole has received United States Food and Drug Authority (USFDA) approval as adjunctive agent for MDD treatment,” said Jimenez.

The studies conducted by Berman and Marcus published in the Journal of Clinical Psychiatry in 2007 provided evidence for the safety and efficacy required for this approval.

The use of aripiprazole as an adjunctive treatment of MDD satisfied the USFDA requirement based on the following: greater remission and response rates, improved scores in the family life and social life domains, placebo level completion rates, good tolerability with acceptable number of serious adverse reactions and discontinuation rate due to these side effects, mean weight change and cholesterol profile.

Based on new comparative data to guide clinicians in the choice of strategy, Dr. Michael Thase, in a clinical opinion, said that augmentation is better than switching.

In switching strategy, clinicians need to taper off one medication slowly while adding on and increasing another. In augmentation, time is not lost, according to Jimenez.

Other factors that make augmentation a better strategy than switching are maintenance of therapeutic optimism and possible acceleration onset of therapeutic effect.

New evidence shows the superiority of augmentation over switching. The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study results revealed that remission rates in augmentation strategy were higher than those using the switching strategy.

Jimenez acknowledged that MDD remains a therapeutic challenge. “Despite the advances in the understanding and treatment of depression over the last decades, failure to achieve an adequate response remains a problem,” Jimenez said.

Otsuka (Philippines) Pharmaceutical Inc. offers aripiprazole, a prescription medicine recently approved by the USFDA and shown by clinical studies to be an effective adjunctive antipsychotic medicine for MDD treatment. A doctor’s prescription and supervision are required.