Set-shifting performance shows which older adults with treatment-resistant depression might respond best to augmentation with aripiprazole, according to a study involving 181 individuals 60 years of age and older.

Investigators looked at the effects of baseline assessments of executive function (set shifting) and response inhibition control, as well as anxiety symptoms and comorbidity. Participants were randomized to receive either aripiprazole (n=91) or placebo (n=90). They started on 2 mg daily. Dose was titrated as tolerated, to a maximum of 15 mg daily. Among the results:

• 43% of people receiving aripiprazole remitted, vs 29% of those who took placebo.

• Baseline set shifting moderated the efficacy of aripiprazole augmentation.

• Among people scoring higher on assessment of response inhibition control, those taking aripiprazole were more likely to experience remission than those taking placebo (53% vs 28%).

• Among people scoring lower, the odds of remission were essentially the same in aripiprazole and placebo groups.

• More severe baseline anxiety predicted a lower remission, but did not moderate aripiprazole efficacy.

Citation: Kaneriya S, Robbins-Welty G, Smagula S, et al. Predictors and moderators of remission with aripiprazole augmentation in treatment-resistant late-life depression: An Analysis of the IRL-GRey randomized clinical trial. [Published online ahead of print March 9, 2016]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2015.3447.