A case report on the safety and efficacy of aripiprazole for depression in Brugada syndrome

Brugada syndrome is a rare genetic cardiac abnormality that has been linked to aggravation of arrhythmias and sudden cardiac death through concomitant medication use, including psychotropic medications. This complicates the clinical team's approach to treatment of depression in patients with Brugada syndrome as many first-line psychotropic agents are recommended to be preferentially avoided. Aripiprazole, which has no formal recommendation for or against use in Brugada syndrome, is approved for augmentation treatment of major depressive disorder therapy. This case report details a male patient with a history of Brugada syndrome who was referred to an intensive outpatient program for worsening of chronic depression. Through a multidisciplinary, shared decision-making approach, aripiprazole was added to the existing regimen of bupropion and duloxetine for augmentation of depression therapy despite minimal evidence in Brugada syndrome. Patient adherence to aripiprazole therapy was reported for approximately 4 weeks with no significant electrocardiogram (ECG) changes compared with baseline. The patient noted subjective improvement in depressive symptoms with the addition of aripiprazole with an objective improvement in Quick Inventory of Depressive Symptomatology total score from moderate-to-mild symptoms. This case report describes 1 of the few cases documenting safe use of aripiprazole to augment depression therapy in a patient with a documented history of Brugada syndrome without potentiating a Brugada-pattern ECG, associated cardiac event, or worsening depression through almost 4 weeks of therapy. More studies regarding the effectiveness and safety of aripiprazole in the augmentation of depression therapy and safety in patients with Brugada syndrome are needed.