Our target population will have been adequately treated with one of three selective
serotonin reuptake inhibitors (SSRIs; escitalopram, citalopram, or sertraline) for at least
8-12 weeks and continue to experience symptoms of depression that have prompted them to seek
additional treatment. Escitalopram, citalopram, and sertraline were selected for use in
this study because they are among the most commonly selected SSRIs and they are associated
with a reduced likelihood of drug-drug interactions with aripiprazole. After completion of
the screening process, eligible participants will be augmented with aripiprazole (5, 10, or
15 mg) for 6 weeks. Participants will continue SSRI treatment with their prescribing
physician, in conjunction with study participation. Symptom severity will be assessed on a
weekly basis, and cognitive and psychosocial function will be assessed at pre- and
post-augmentation. We hypothesize that aripiprazole augmentation will be associated with
reductions in symptom severity, and with improved performance on measures of psychosocial
and cognitive function.
- Age 18-65
- Primary diagnosis of Major Depressive Disorder (MDD)
- Completion of at least 8-12 weeks (and no longer than 6 months) of treatment with
escitalopram, citalopram, or sertraline, with at least 6 weeks at an adequate dose
(i.e., 20 mg escitalopram; 40 mg citalopram; 150 mg sertraline)
- Hamilton Rating Scale for Depression, 17-item (HRSD17) score less than or equal to 14
and/or Clinical Global Impression - Severity (CGI-S) score less than or equal to 3
- Self-reported difficulties with cognition and/or concentration, and an Inventory for
Depressive Symptomatology Clinician-Rated, 30-item (IDS-C30) item #16 (Concentration
and Decision Making) score less than or equal to 2
- Ability to read and write in English (required because instructions for cognitive
testing and several questionnaires are available only in English)
- Presence of untreated or unstable comorbid medical condition based on physician
information or evidence at examination, such as hypertension, diabetes,
- Presence of known cardiovascular disease or seizure disorder.
- Presence of other primary psychiatric disorders or conditions (including depression
due to medical conditions, currently suicidal or high suicide risk, current or past
psychotic disorders of any type, bipolar disorder (I, II, or Not Otherwise Specified
[NOS]), schizophrenia, schizoaffective disorder, anorexia, bulimia, obsessive
compulsive disorder, alcohol or substance abuse or dependence within the last 6
- Presence of organic brain injury or dementia, based on a cutoff score of < 20 on the
Mini Mental Status Examination (MMSE).
- Concomitant pharmacological or psychotherapeutic treatment (in addition to one SSRI
as described in Inclusion Criteria) including but not limited to anxiolytics,
neuroleptics, mood stabilizers
- Hospitalization for mental illness within the past year.
- For women, currently pregnant or planning to become pregnant in the next year.