From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
For older adults with severe depression and anxiety who are already taking Lexapro (escitalopram), aripiprazole is a recommended adjunct medication, typically starting at a low dose, as it has been shown to be effective in treating unipolar, nonpsychotic depression 1.
Adjunct Medication Options
When considering adjunct medications to escitalopram for severe depression and anxiety in older adults, several options can be evaluated. The choice of medication should be based on the individual patient's needs, medical history, and potential interactions with other medications.
- Bupropion (Wellbutrin) is often considered due to its complementary mechanism of action, affecting dopamine and norepinephrine, which can be beneficial for patients who have not responded adequately to SSRIs like escitalopram.
- Mirtazapine (Remeron) can be useful, especially for patients with sleep and appetite issues, as it can help address these symptoms while also treating depression and anxiety.
- Buspirone (BuSpar) may be considered for anxiety, starting at a low dose and gradually increasing as needed and tolerated.
Considerations for Older Adults
It's crucial to start with lower doses and gradually increase as tolerated to minimize side effects. Close monitoring during the initial weeks of adding any new medication is essential to assess for effectiveness and potential side effects, which can be more pronounced in older adults.
Evidence-Based Recommendations
The most recent and highest quality study 2 suggests that psychological therapies, including cognitive behavioral therapy, behavioral therapy, and reminiscence therapy, may be effective in reducing depressive symptoms in older adults residing in long-term care settings. However, when considering pharmacological adjuncts to escitalopram, aripiprazole stands out as a recommended option due to its FDA indication for adjunctive treatment in unipolar, nonpsychotic depression 1. This recommendation prioritizes the patient's morbidity, mortality, and quality of life outcomes.