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Letters to the Editor   |    
Aripiprazole Adjunctive to Antidepressant Therapy
Ronald M. Marcus, M.D.; Raymond Sanchez, M.D.; Marianne Frost, M.S.; Robert D. McQuade, Ph.D.
Am J Psychiatry 2011;168:211-211. doi:10.1176/appi.ajp.2010.10101515
View Author and Article Information
Wallingford, Conn.
Princeton, N.J.
Wallingford, Conn.
Princeton, N.J.

Dr. Marcus has received support from Bristol-Myers Squibb; and he is employed by Bristol-Myers Squibb. Dr. Sanchez has received support from Otsuka Pharmaceutical Development and Commercialization, Inc. Ms. Frost has received support from Bristol-Myers Squibb; and she is employed by Bristol-Myers Squibb. Dr. McQuade has received support from Otsuka Pharmaceutical Development and Commercialization, Inc; he is employed by Otsuka Pharmaceutical Development and Commercialization, Inc.; and he is a shareholder with Bristol-Myers Squibb.

accepted for publication in December 2010.

Accepted December , 2010.

To the Editor: We would like to clarify the dosing for aripiprazole adjunctive to antidepressant therapy in patients with major depressive disorder as suggested in the American Psychiatric Association (APA) Practice Guideline for the Treatment of Patients With Major Depressive Disorder (1), published as a supplement to the October 2010 issue of the Journal. The medication product information states that for adjunctive treatment of major depressive disorder, aripiprazole should be initiated at 2—5 mg per day, with a target dose of 5—10 mg per day and a maximum dose of 15 mg/day. Dose adjustments of up to 5 mg/day should occur gradually, at intervals of no less than 1 week, and no dosage adjustments are needed for the current antidepressant.

The current guidelines state that adjunctive aripiprazole is typically initiated at 2.5—5 mg/day and titrated upward as tolerated to a maximum dose of 30 mg/day. In the study cited for this recommendation (2), adjunctive aripiprazole was initiated at 5 mg/day and, if tolerability permitted, increased to the target dose of 10 mg/day at the start of week 2. The dose could be reduced to 2 mg if necessary for tolerability. The maximal dose in the study was 20 mg/day. There is no recommendation in the product information for a maximum dose of 30 mg/day for aripiprazole adjunctive to antidepressants. When making treatment decisions, it is important to consider the doses that were studied in three large, placebo-controlled, double-blind clinical trials for aripiprazole adjunctive to antidepressants in the treatment of major depressive disorder (24), and these data provide the foundation for the recommended doses in the product information.

American Psychiatric Association:  American Psychiatric Association Practice Guideline for the Treatment of Patients With Major Depressive Disorder.  Am J Psychiatry 2010; 167(suppl):A34
[CrossRef]
 
Berman  RM;  Marcus  RN;  Swanink  R;  McQuade  RD;  Carson  WH;  Corey-Lisle  PK;  Khan  A:  The efficacy and safety of aripiprazole as adjunctive therapy in major depressive disorder: a multicenter, randomized, double-blind, placebo-controlled study.  J Clin Psychiatry 2007; 68:843—853
[CrossRef] | [PubMed]
 
Marcus  RN;  McQuade  RD;  Carson  WH;  Hennicken  D;  Fava  M;  Simon  JS;  Trivedi  MH;  Thase  ME;  Berman  RM:  The efficacy and safety of aripiprazole as adjunctive therapy in major depressive disorder: a second multicenter, randomized, double-blind, placebo-controlled study.  J Clin Psychopharmacol 2008; 28:156—165
[CrossRef] | [PubMed]
 
Berman  RM;  Fava  M;  Thase  ME;  Trivedi  MH;  Swanink  R;  McQuade  RD;  Carson  WH;  Adson  D;  Taylor  L;  Hazel  J;  Marcus  RN:  Aripiprazole augmentation in major depressive disorder: a double-blind, placebo-controlled study in patients with inadequate response to antidepressants.  CNS Spectr 2009; 14:197—206
[PubMed]
 
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References

American Psychiatric Association:  American Psychiatric Association Practice Guideline for the Treatment of Patients With Major Depressive Disorder.  Am J Psychiatry 2010; 167(suppl):A34
[CrossRef]
 
Berman  RM;  Marcus  RN;  Swanink  R;  McQuade  RD;  Carson  WH;  Corey-Lisle  PK;  Khan  A:  The efficacy and safety of aripiprazole as adjunctive therapy in major depressive disorder: a multicenter, randomized, double-blind, placebo-controlled study.  J Clin Psychiatry 2007; 68:843—853
[CrossRef] | [PubMed]
 
Marcus  RN;  McQuade  RD;  Carson  WH;  Hennicken  D;  Fava  M;  Simon  JS;  Trivedi  MH;  Thase  ME;  Berman  RM:  The efficacy and safety of aripiprazole as adjunctive therapy in major depressive disorder: a second multicenter, randomized, double-blind, placebo-controlled study.  J Clin Psychopharmacol 2008; 28:156—165
[CrossRef] | [PubMed]
 
Berman  RM;  Fava  M;  Thase  ME;  Trivedi  MH;  Swanink  R;  McQuade  RD;  Carson  WH;  Adson  D;  Taylor  L;  Hazel  J;  Marcus  RN:  Aripiprazole augmentation in major depressive disorder: a double-blind, placebo-controlled study in patients with inadequate response to antidepressants.  CNS Spectr 2009; 14:197—206
[PubMed]
 
References Container
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