Comparison of the efficacy and safety of bupropion versus aripiprazole augmentation in adults with treatment-resistant depression: a nationwide cohort study in South Korea
Abstract Background Treatment-resistant depression (TRD) affects 10–30% of patients with major depressive disorder, leading to increased comorbidities, higher mortality, and significant economic and social burdens. This study aimed to compare the efficacy and safety of bupropion and aripiprazole a...
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Cambridge University Press
2025-01-01
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| Series: | European Psychiatry |
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| Online Access: | https://www.cambridge.org/core/product/identifier/S0924933824018157/type/journal_article |
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| author | Dong Yun Lee Rae Woong Park Soo Min Jeon |
| author_facet | Dong Yun Lee Rae Woong Park Soo Min Jeon |
| author_sort | Dong Yun Lee |
| collection | DOAJ |
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Abstract
Background
Treatment-resistant depression (TRD) affects 10–30% of patients with major depressive disorder, leading to increased comorbidities, higher mortality, and significant economic and social burdens. This study aimed to compare the efficacy and safety of bupropion and aripiprazole as augmentation therapies for TRD.
Methods
This population-based, retrospective cohort study included adults aged ≥18 years with a diagnosis of depressive disorder who met the criteria for TRD. Data were collected from a nationwide claims database in South Korea. Patients prescribed bupropion were matched 1:1 with those prescribed aripiprazole. Subgroup analyses were performed according to age. An as-treated analysis was performed as the primary analysis, and an intention-to-treat analysis was performed to identify different risk windows. The primary outcome was depression-related hospitalization, and the secondary outcomes were first-time diagnoses of movement disorder and seizure.
Results
A total of 5,619 patients (bupropion: n = 1,568; aripiprazole: n = 4,051) were included in this study. Bupropion was associated with lower risks of hospitalization (hazard ratio [HR]: 0.51; 95% confidence interval [CI] 0.29–0.86) and movement disorders (HR: 0.56; 95% CI 0.36–0.85) than aripiprazole. No significant difference in seizure risk (HR: 0.65; 95% CI 0.30–1.31) was observed between the two treatments. The subgroup analysis of participants aged ≥60 years revealed no significant differences in the three outcomes between the two medications.
Conclusions
Bupropion augmentation is associated with a significantly lower risk of depression-related re-hospitalization and movement disorders in patients with TRD. Therefore, bupropion augmentation can be a comprehensive treatment strategy for TRD.
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| format | Article |
| id | doaj-art-7ee5980234ed41f4aa9eda0d905ccdbc |
| institution | Kabale University |
| issn | 0924-9338 1778-3585 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | European Psychiatry |
| spelling | doaj-art-7ee5980234ed41f4aa9eda0d905ccdbc2025-02-03T10:36:38ZengCambridge University PressEuropean Psychiatry0924-93381778-35852025-01-016810.1192/j.eurpsy.2024.1815Comparison of the efficacy and safety of bupropion versus aripiprazole augmentation in adults with treatment-resistant depression: a nationwide cohort study in South KoreaDong Yun Lee0https://orcid.org/0000-0002-3678-9862Rae Woong Park1https://orcid.org/0000-0003-4989-3287Soo Min Jeon2https://orcid.org/0000-0002-5100-5739Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea Bongdam Forest Mental Health Clinic, Hwaseong, Republic of KoreaDepartment of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, South KoreaJeju Research Institute of Pharmaceutical Science, College of Pharmacy, Jeju National University, Jeju, South Korea Abstract Background Treatment-resistant depression (TRD) affects 10–30% of patients with major depressive disorder, leading to increased comorbidities, higher mortality, and significant economic and social burdens. This study aimed to compare the efficacy and safety of bupropion and aripiprazole as augmentation therapies for TRD. Methods This population-based, retrospective cohort study included adults aged ≥18 years with a diagnosis of depressive disorder who met the criteria for TRD. Data were collected from a nationwide claims database in South Korea. Patients prescribed bupropion were matched 1:1 with those prescribed aripiprazole. Subgroup analyses were performed according to age. An as-treated analysis was performed as the primary analysis, and an intention-to-treat analysis was performed to identify different risk windows. The primary outcome was depression-related hospitalization, and the secondary outcomes were first-time diagnoses of movement disorder and seizure. Results A total of 5,619 patients (bupropion: n = 1,568; aripiprazole: n = 4,051) were included in this study. Bupropion was associated with lower risks of hospitalization (hazard ratio [HR]: 0.51; 95% confidence interval [CI] 0.29–0.86) and movement disorders (HR: 0.56; 95% CI 0.36–0.85) than aripiprazole. No significant difference in seizure risk (HR: 0.65; 95% CI 0.30–1.31) was observed between the two treatments. The subgroup analysis of participants aged ≥60 years revealed no significant differences in the three outcomes between the two medications. Conclusions Bupropion augmentation is associated with a significantly lower risk of depression-related re-hospitalization and movement disorders in patients with TRD. Therefore, bupropion augmentation can be a comprehensive treatment strategy for TRD. https://www.cambridge.org/core/product/identifier/S0924933824018157/type/journal_articleantidepressantsaugmentationdepressiontreatment-resistant depression |
| spellingShingle | Dong Yun Lee Rae Woong Park Soo Min Jeon Comparison of the efficacy and safety of bupropion versus aripiprazole augmentation in adults with treatment-resistant depression: a nationwide cohort study in South Korea European Psychiatry antidepressants augmentation depression treatment-resistant depression |
| title | Comparison of the efficacy and safety of bupropion versus aripiprazole augmentation in adults with treatment-resistant depression: a nationwide cohort study in South Korea |
| title_full | Comparison of the efficacy and safety of bupropion versus aripiprazole augmentation in adults with treatment-resistant depression: a nationwide cohort study in South Korea |
| title_fullStr | Comparison of the efficacy and safety of bupropion versus aripiprazole augmentation in adults with treatment-resistant depression: a nationwide cohort study in South Korea |
| title_full_unstemmed | Comparison of the efficacy and safety of bupropion versus aripiprazole augmentation in adults with treatment-resistant depression: a nationwide cohort study in South Korea |
| title_short | Comparison of the efficacy and safety of bupropion versus aripiprazole augmentation in adults with treatment-resistant depression: a nationwide cohort study in South Korea |
| title_sort | comparison of the efficacy and safety of bupropion versus aripiprazole augmentation in adults with treatment resistant depression a nationwide cohort study in south korea |
| topic | antidepressants augmentation depression treatment-resistant depression |
| url | https://www.cambridge.org/core/product/identifier/S0924933824018157/type/journal_article |
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