Effects of Adjunctive Brexpiprazole on Chronobiologic Parameters in Patients With Major Depressive Disorder and Sleep Disturbances
This poster was presented at the 30th annual Psych Congress, held Sept. 16-19, 2017, in New Orleans, Louisiana.
Background: Sleep disturbances are frequent in major depressive disorder (MDD). Circadian rhythm disturbances and changes in melatonin and cortisol patterns may contribute to sleep symptomatology; the increased phase angle between melatonin and cortisol has been suggested as a potential biomarker for MDD. Brexpiprazole is a serotonin-dopamine activity modulator that is a partial agonist at serotonin 5-HT1A and dopamine D2 receptors, and antagonist at serotonin 5-HT2A and noradrenaline alpha1B/2C receptors, all with similar potency. We evaluated the effects of adjunctive brexpiprazole on chronobiologic parameters of sleep in patients with MDD and inadequate response to antidepressant therapy (ADT) (NCT01942733).
Methods: Enrolled patients continued treatment with their current ADT for 2 weeks. Those who still had an inadequate response and experiencing sleep disturbances, received 8-week open-label treatment with their current ADT and adjunctive brexpiprazole (1-3 mg/day).
Results: At week 8, total scores on the Biological Rhythm Interview of Assessment in Neuropsychiatry (BRIAN), assessing disturbances in circadian rhythms, demonstrated a mean improvement of -17 points from a baseline of 52 points (N=41). Time to melatonin onset (trough), peak cortisol levels, and the phase angle (difference in time between melatonin onset and cortisol peak) was calculated at baseline and week 8 for a subgroup of 9 patients. At week 8, the phase angle had decreased from 653 minutes (SD 106) to 545 minutes (SD 155).
Conclusion: The normalization of circadian rhythms (BRIAN) and melatonin trough/peak cortisol levels after 8-week treatment with adjunctive brexpiprazole may contribute to overall improvements in sleep and symptoms of depression.