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July 11, 2017

Lessons Learned From the VA Augmentation and Switching Treatments for Improving Depression Outcomes (VAST-D) Study

Author Affiliations
  • 1Division of Clinical Research, Massachusetts General Hospital, Boston
JAMA. 2017;318(2):126-128. doi:10.1001/jama.2017.8030

In this issue of JAMA, Mohamed and colleagues1 report the outcome of an important multicenter clinical trial, the Veterans Affairs Augmentation and Switching Treatments for Improving Depression Outcomes (VAST-D) Study. The study, conducted with scientific rigor and sophisticated clinical trial methodology, compared the relative effectiveness and safety of 3 commonly used treatment options for 1522 patients with major depressive disorder (MDD) with inadequate response to antidepressant therapy: switching to a different antidepressant, which was bupropion in this study (n = 511); augmenting current treatment with bupropion (n = 506); or augmenting current treatment with an atypical antipsychotic drug, which was aripiprazole in this study (n = 505). The primary outcome was remission of depression (defined as a 16-item Quick Inventory of Depressive Symptomatology-Clinician Rated [QIDS-C16] questionnaire score of ≤5 at 2 consecutive visits) after 12 weeks of acute treatment. Additional outcomes included response (≥50% reduction in QIDS-C16 score or improvement on the Clinical Global Impression [CGI] Global Improvement scale), as well as relapse, and adverse effects. Patients who achieved remission at 12 weeks (n = 396) were followed for relapse for up to 36 weeks after randomization.