Led by the moderator, the panelists discussed brexpiprazole's pivotal two-phase trial design and how its reduced intrinsic dopamine partial agonism and lower starting doses contributed to fewer akathisia events than aripiprazole, followed by cariprazine's D3-preferring mechanism and more favorable metabolic and sedation profile.
The panelists examined aripiprazole's pivotal trial design, which used an antidepressant lead-in phase followed by randomization to placebo or active drug among non-responders, with Thase detailing how dose-finding evolved toward lower 5 mg and 10 mg doses to minimize akathisia, the primary dose-limiting side effect, while preserving antidepressant benefit at doses lower than those used for antipsychotic indications.
Led by the moderator, the expert mental health experts examined how tolerability shapes agent selection, with Wilkinson highlighting metabolic side effects and akathisia — most pronounced with aripiprazole — as key counseling points, alongside the value of anticipatory guidance in building patient trust and preventing premature discontinuation.
Led by the moderator, the panelists discussed persistent efficacy, tolerability, and adherence gaps in antidepressant treatment, noting that only about 60% of patients with MDD receive treatment and roughly 30% develop treatment resistance, with early adverse effects often undermining adherence before benefits take hold.
Major depressive disorder (MDD) is a heterogeneous disorder with many unique symptom combinations.
Welcome back to another AJMC Peer Exchange series. In this episode titled, "The Burden of Major Depressive Disorder: Setting the Stage for Managed Care."
