To Assess the Safety and Tolerability of an Oral Aripiprazole/Escitalopram Combination Therapy in Participants With Major Depressive Disorder (MDD)

An AE was defined as any untoward medical occurrence in a clinical investigation participant administered a drug; it did not necessarily have to have a causal relationship with this treatment. An AE was considered serious if it was fatal; life-threatening; persistently or significantly disabling or incapacitating; required in-patient hospitalization or prolonged hospitalization; a congenital anomaly/birth defect; or other medically significant event that, based upon appropriate medical judgment, may have jeopardized the participant and may have required medical or surgical intervention. TEAE is defined as an adverse event that started after start of study drug treatment. The Common Terminology Criteria for Adverse Events v3.0 (CTCAE) was used to determine the severity wherein Grade 1=mild AE, Grade 2=moderate AE, Grade 3=severe AE, Grade 4=life-threatening or disabling AE, Grade 5=death related to AE.

Time frame: From first dose up to 30 days post last dose (Up to approximately 40 weeks)

Population: Safety Sample included all participants who received in the Treatment Phase at least one dose of aripiprazole/escitalopram combination medication as indicated on the dosing record.

The AIMS is a 12-item scale. The first 10 -items are rated from 0 to 4 (0=best, 4=worst). An item score of 0, depending on the item, either means: no abnormal involuntary movement (AIM), or no incapacitation due to AIM, or no awareness of AIM. An item score of 4 either means: severe AIM, or severe incapacitation due to AIM, or being aware of, and severe distress caused by AIM. Items 11 and 12, related to dental status, have dichotomous responses, 0=no and 1=yes. The AIMS Total Score is the sum of the ratings for the first seven items. The possible total scores are from 0 to 28, where a higher score indicates worst outcome. A negative mean change from Baseline indicates improvement.

Time frame: Baseline; Weeks 1, 2, 4, 6, 8, 14, 20, 26, 32 and End of the study visit (Week 43 or before)

Population: Safety Sample included all participants who received in the Treatment Phase at least one dose of aripiprazole/escitalopram combination medication as indicated on the dosing record. Number analyzed is the number of participants with data available at the given time point.

The BARS is used to assess the presence and severity of akathisia. This scale consists of 4 items. Only item 4, the 'Global Clinical Assessment of Akathisia', was evaluated for this outcome measure. This item is rated on a 6-point scale, with 0 being best (absent) and 5 being worst (severe akathisia). A negative mean change from Baseline indicates improvement.

Time frame: Baseline; Weeks 1, 2, 4, 6, 8, 14, 20, 26, 32 and End of the study visit (Week 43 or before)

Population: Safety Sample included all participants who received in the Treatment Phase at least one dose of aripiprazole/escitalopram combination medication as indicated on the dosing record. Number analyzed is the number of participants with data available at the given time point.

BMI= weight(kg)/\[height(m)\^2\].

Time frame: Baseline, Week 26 and End of the study visit (Week 43 or before)

Population: Safety Sample included all participants who received in the Treatment Phase at least one dose of aripiprazole/escitalopram combination medication as indicated on the dosing record. Number analyzed is the number of participants with at least one observation at the given timepoint.

Time frame: Baseline; Weeks 1, 2, 4, 6, 8, 14, 20, 26, 32 and End of the study visit (Week 43 or before)

Population: Safety Sample included all participants who received in the Treatment Phase at least one dose of aripiprazole/escitalopram combination medication as indicated on the dosing record. Number analyzed is the number of participants with data available for analysis at the given timepoint.

The severity of illness was rated using a 7-point CGI-S. CGI-S scores range from 1 to 7, where 1=normal, not at all ill, 2=borderline mentally ill, 3=mildly ill, 4=moderately ill, 5=markedly ill, 6=severely ill, 7=among the most extremely ill participants. A negative mean change from Baseline indicates improvement.

Time frame: Baseline; Weeks 1, 2, 4, 6, 8, 14, 20, 26, 32 and End of the study visit (Week 43 or before)

Population: Intent-to-treat (ITT) Sample included all participants in the Safety Sample with at least one CGI-S assessment in the Treatment Phase, with data available for analysis. Number analyzed is the number of participants with data available at the given time point.

The MGH SFI is a measure of a participant's self-reported sexual functioning. The MGH SFI included 5 questions at the baseline assessment, each addressing experiences over the last month: Question a) interest in sex, Question b) ability to get sexually aroused, Question c) ability to achieve orgasm, Question d) ability to get and maintain an erection, and Question e) overall sexual satisfaction. The MGH SFI at post-baseline visits included one additional question: Question f) overall improvement since the last medication change. Each question/item is rated from 1 through 6. For questions a) through e), a score of 1 indicates 'greater than normal', and 6 'totally absent'. For question f), a score of 1 indicates 'very much improved', and 6 'much worse'. All question scores are analyzed separately. No total or mean score is derived. Each subscale score ranges from 0 to 6, higher scores indicates worsening. A negative mean change from Baseline indicates improvement.

Time frame: Baseline, Weeks 8, 26 and End of the study visit (Week 43 or before)

Population: Safety Sample included all participants who received in the Treatment Phase at least one dose of aripiprazole/escitalopram combination medication as indicated on the dosing record. Number analyzed is the number of participants with data available at the given time point.

The HbA1c is also known as glycosylated hemoglobin. It is the concentration of glucose bound to hemoglobin as a percent of the absolute maximum that can be bound. The mean change in the value of HbA1c was analyzed relative to Baseline. The HbA1c of \<6.0% signifies the normal blood glucose level. A negative mean change from Baseline indicates improvement.

Time frame: Baseline, Week 8, and End of the study visit (Week 43 or before)

Population: Safety Sample included all participants who received in the Treatment Phase at least one dose of aripiprazole/escitalopram combination medication as indicated on the dosing record. Number analyzed is the total number of participants with at least one observation of the given parameter.

Prolactin is a hormone released by the pituitary gland. The prolactin test measures the amount of prolactin in the blood. Prolactin is responsible for the breast growth and milk production during pregnancy and after birth. The normal prolactin levels range from 20 to 25 ng/mL in males and females and 80 to 400 ng/mL in pregnant women. A negative mean change from Baseline indicates reduction in the prolactin levels.

Time frame: Baseline, Weeks 8, 26, and End of the study visit (Week 43 or before)

Population: Safety Sample included all participants who received in the Treatment Phase at least one dose of aripiprazole/escitalopram combination medication as indicated on the dosing record. Number analyzed is the total number of participants with at least one observation of the given parameter.

The CPFQ is a brief self-rated scale developed to measure cognitive and executive dysfunction in mood and anxiety disorders. It consists of 7 items. The CPFQ total score ranges from 7 to 42, with higher score representing less satisfaction in cognitive and physical functioning. A negative mean change from Baseline indicates improvement.

Time frame: Baseline, Weeks 8, 26 and End of the study visit (Week 43 or before)

Population: Safety Sample included all participants who received in the Treatment Phase at least one dose of aripiprazole/escitalopram combination medication as indicated on the dosing record, with data available for analysis. Number analyzed is the number of participants with data available at the given time point.

The severity of illness was rated using a 7-point PGI-S. PGI-S scores range from 1 to 7, where 1=not depressed at all, 2=only occasionally depressed to a mild degree, 3=mildly depressed half the time, 4=moderately depressed most of the time, 5=moderately depressed almost all of the time, 6=severely depressed all the time, 7=extremely depressed all the time. A negative mean change from Baseline indicates improvement.

Time frame: Baseline; Weeks 1, 2, 4, 6, 8, 14, 20, 26, 32 and End of the study visit (Week 43 or before)

Population: Intent-to-treat (ITT) Sample included all participants in the Safety Sample with at least one CGI-S assessment in the Treatment Phase, with data available for analysis. Number analyzed is the number of participants with data available at the given time point.

The Q-LES-Q-SF is a self-report measure designed to enable investigators to easily obtain sensitive measures of the degree of enjoyment and satisfaction experienced by participants in various areas of daily functioning with the help of 14 items of total 16 items of the scale. The overall general subscore is obtained using 14 items of the scale. Each item is scored on a 5-point scale, with 1= Very Poor; 2=Poor; 3=Fair; 4=Good; 5=Very Good. The raw scores are computed to an overall general subscore of 0 to 100 where lower scores indicate less enjoyment or satisfaction with the activity. A positive change from Baseline indicates improvement.

Time frame: Baseline, Week 8, 26 and End of the study visit (Week 43 or before)

Population: Safety Sample included all participants who received in the Treatment Phase at least one dose of aripiprazole/escitalopram combination medication as indicated on the dosing record, with data available for analysis. Number analyzed is the number of participants with data available at the given time point.

The SDS is a self-rated instrument used to measure the effect of the participant's symptoms on work/school, social life, and family/home responsibilities. For each of the three items, scores range from 0 through 10. The number most representative of how much each area was disrupted by symptoms was marked along the line from 0= not at all, to 10= extremely. For the work/school item, no response was to be entered if the participant did not work or go to school for reasons unrelated to the disorder and a response therefore not being applicable. The SDS Mean Score of 0 to 10 was calculated as an average of the three item scores. All three item scores needed to be available with the exception of the work/school item score when this item was not applicable. A negative mean change from Baseline indicates improvement.

Time frame: Baseline, Weeks 8, 26 and End of the study visit (Week 43 or before)

Population: Safety Sample included all participants who received in the Treatment Phase at least one dose of aripiprazole/escitalopram combination medication as indicated on the dosing record, with data available for analysis. Number analyzed is the number of participants with data available at the given time point.

The SAS is a rating scale used to measure extrapyramidal symptoms (EPS). The SAS is a 10-item scale, with each item rated from 1 to 5, with 1 being normal and 5 being the worst. The SAS total score is the sum of ratings for all 10 items, with possible total scores from 10 to 50. A negative mean change from Baseline indicates improvement.

Time frame: Baseline; Weeks 1, 2, 4, 6, 8, 14, 20, 26, 32 and End of the study visit (Week 43 or before)

Population: Safety Sample included all participants who received in the Treatment Phase at least one dose of aripiprazole/escitalopram combination medication as indicated on the dosing record. Number analyzed is the number of participants with data available at the given time point.

Incidence of clinically relevant abnormal ECG values were reported as change from Baseline in heart rate (Tachycardia - ≥15 beats per minute (bpm), Bradycardia ≤15 bpm; Rhythm (Sinus tachycardia ≥15 bpm increase, Sinus bradycardia decrease of ≥15 bpm from Baseline); Presence of - supraventricular premature beat; ventricular premature beat; supraventricular tachycardia; ventricular tachycardia; atrial fibrillation and flutter. Conduction - Presence of primary, secondary or tertiary atrioventricular block, left bundle-branch block, right bundle-branch block, pre-excitation syndrome, other intraventricular conduction blocked QRS ≥0.12 second increase of ≥0.02 second. Acute, subacute or old Infarction, Presence of myocardial ischemia, symmetrical T-wave inversion. Increase in QTc - QTc ≥450 msec ≥10% increase. Any clinically significant change from Baseline assessed by the Investigator are reported. Only categories with at least 1 participant with event are reported.

Time frame: Up to 40 weeks

Population: Safety Sample included all participants who received in the Treatment Phase at least one dose of aripiprazole/escitalopram combination medication as indicated on the dosing record. Number analyzed is the total number of participants with baseline and at least one post-baseline numeric result for the given ECG parameter.

The laboratory values were one of the parameters to measure the safety and tolerability of individual participants. Participants with potentially clinically significant lab values in serum chemistry, hematology, urinalyses and prolactin tests that were identified based on pre-defined criteria were reported. Any value outside the normal range was flagged for the attention of the investigator who assessed whether or not a flagged value is of clinical significance. The categories with at least one participants with abnormal lab value as assessed by the Investigator are reported.

Time frame: Up to 40 weeks

Population: Safety Sample included all participants who received in the Treatment Phase at least one dose of aripiprazole/escitalopram combination medication as indicated on the dosing record. Number analyzed is the total number of participants with at least one post-baseline numeric result for the given lab test.

Time frame: Up to 40 weeks

Population: Safety Sample included all participants who received in the Treatment Phase at least one dose of aripiprazole/escitalopram combination medication as indicated on the dosing record.

Criteria for potentially clinically significant vital sign abnormalities: Heart rate \[beats per minute (BPM)\]: \>120, increase \>=15, \<50, decrease \>=15; systolic blood pressure \[millimeter of mercury (mmHg)\]: \>180, increase \>=20, \<90, decrease \>=20; diastolic blood pressure (mmHg): \>105, increase \>=15, \<50, decrease \>=15; orthostatic hypotension: \>=20 mmHg decrease in systolic blood pressure and \>=25 bpm increase in heart rate from supine to sitting; weight (kg) gain: increase \>=7%; or weight loss: decrease \>=7%. Only categories with at least 1 participant with event are reported.

Time frame: Up to 40 weeks

Population: Safety Sample included all participants who received in the Treatment Phase at least one dose of aripiprazole/escitalopram combination medication as indicated on the dosing record. Number analyzed is the number of participants with at least one post-baseline numeric result for the given vital sign parameter.

The suicidal ideation compared to Baseline was measured by an increase in suicidal ideation category (1-5 on the C-SSRS) during treatment from the maximum suicidal ideation category at Baseline, or any suicidal ideation during treatment if there is none at Baseline. C-SSRS is used to assess whether participant experienced suicidal ideation (Question 1: wish to be dead; Question 2: non-specific active suicidal thoughts; Question 3: active suicidal ideation with any methods (not plan) without intent to act; Question 4: active suicidal ideation with some intent to act, without specific plan; Question 5: active suicidal ideation with specific plan and intent). A negative change from Baseline indicates improvement. Only those categories and timepoints which have data are reported.

Time frame: Baseline; Weeks 1, 2, 4, 6, 8, 14 and Last Visit (Week 43 or before)

Population: Safety Sample included all participants who received in the Treatment Phase at least one dose of aripiprazole/escitalopram combination medication as indicated on the dosing record.