The authors of an accompanying comment article note that treatment-resistant late-life depression is a major issue faced by psychiatrists treating people with depression aged >60 years. Although unipolar depression has often been assumed to be the same in adults of all ages, this is now known not to be the case and the current research is therefore welcome. This is the first randomised, double-blind trial in treatment-resistant late-life major depression, and it supports the use of antipsychotic augmentation in this setting. Further studies are however required to evaluate the efficacy of augmentation with other drugs, and whether augmentation with aripiprazole should be continued longer-term. Longer-term data are also required to determine the safety of this treatment approach, as although there were no major concerns raised about effects on weight or QT interval, treatment duration was short.
The NICE guideline on depression in adults recommends augmenting an antidepressant with 1) lithium or 2) an antipsychotic such as aripiprazole, olanzapine, quetiapine or risperidone or 3) another antidepressant such as mirtazapine or mianserin. There are no specific recommendations on the management of older people with severe depression, and the guideline does in fact state that treatment strategies should not be routinely varied by personal characteristics. Antidepressants for older people should be prescribed at an age-appropriate dose taking into account the effect of general physical health and concomitant medication on pharmacokinetics and pharmacodynamics, and side-effects should be carefully monitored for.
This guideline is currently being updated (expected in 2017).