Bech P, Fava M, Trivedi MH, Wisniewski SR, Rush AJ. Outcomes on the pharmacopsychometric triangle in bupropion‐SR vs. buspirone augmentation of citalopram in the STAR*D trial.

Objective:  To compare within the framework of a novel pharmacopsychometric triangle, augmentation treatment with bupropion vs. buspirone in the acute therapy of major depression in the STAR*D study. The triangle provides a composite view in three domains of antidepressive activity, side effects, and quality of life.

Method:  Within the pharmacopsychometric triangle, the short six‐item subscales of the Hamilton Depression Scale (HAM‐D₁₇) and of the Inventory of Depressive Symptomatology (IDS‐C₃₀), referred to as HAM‐D₆ and IDS‐C₆, were focussed on pure antidepressive effect. Side‐effects (tolerable vs. intolerable) and quality of life were measured using patient‐administered questionnaires. A modified intention to treat sample was used.

Results:  Within the pharmacopsychometric triangle, bupropion‐SR (sustained release) was superior to buspirone when augmented to the current citalopram treatment. Thus, in the domain of pure antidepressive effect, bupropion‐SR was superior (P = 0.05) on the HAM‐D₆, IDS‐C₆, and IDS‐C₃₀, but not on the HAM‐D₁₇. In the domain of side effects, the total scores on the Patient Rated Inventory of Side Effects (PRISE) were reduced significantly more by bupropion‐SR than by buspirone (P = 0.03). In the domain of quality of life, the total scores on the Quality of Life Enjoyment and Satisfaction Questionnaire (QLES‐Q) showed a trend (P = 0.10) from baseline to endpoint of a superiority for bupropion‐SR compared with buspirone.

Conclusion:  In all domains of the pharmacopsychometric triangle, bupropion‐SR was superior to buspirone as augmentation therapy in depressed outpatients not responding to citalopram.