Saskatchewan Psychiatrists’ and Psychiatry Residents’ Perspectives on Aripiprazole and Brexpiprazole Use in Major Depressive Disorder

Background: About 14% of Canadian will experience major depressive disorder (MDD) during their lifetime. Partial dopamine agonist antipsychotics (i.e., aripiprazole and brexpiprazole) are first-line adjunctive pharmacotherapy for difficult-to-treat depression in the 2023 Canadian Network for Mood and Anxiety Treatment guidelines. These medications are not covered for MDD on the Saskatchewan Drug Formulary.

Objectives: As part of an advocacy initiative for their inclusion on the formulary, our project aims to assess the perspectives of Saskatchewan-based psychiatrists and psychiatry residents regarding the use of aripiprazole and brexpiprazole for MDD.

Methods: A cross-sectional, self-directed, online survey was conducted. The questionnaire included selection-based and open-ended questions.

Results: Forty-three participants completed the survey (response rate of 23% (43/190)). Approximately forty percent of respondents prescribe aripiprazole and brexpiprazole for MDD in half of patient cases when indicated (15/42). Most respondents view aripiprazole and brexpiprazole as being more effective and better tolerated compared to other adjunctive treatments. The number one barrier to prescribing both is a lack of coverage.

Conclusion: Saskatchewan psychiatrists understand the role of aripiprazole and brexpiprazole for MDD treatment; however, Saskatchewan residents are unable to access these medications due to formulary restrictions. These findings will support advocacy initiatives for provincial coverage.