Augmentation and combination strategies in treatment-resistant depression

Area of Science:

• Neuroscience
• Pharmacology
• Psychiatry

Background:

• Many patients with depression exhibit partial or no response to standard antidepressant treatments.
• Residual symptoms are common even in patients who initially respond to antidepressants.

Purpose of the Study:

• To review augmentation and combination strategies for treatment-resistant depression (TRD).
• To assess the current evidence and clinical utility of these strategies.

Main Methods:

• Review of existing controlled clinical trials, anecdotal reports, case series, and uncontrolled trials.
• Analysis of strategies involving adding non-antidepressant agents (augmentation) or combining different antidepressants.

Main Results:

• Augmentation and combination strategies appear safe and effective for TRD, despite limited controlled studies.
• These strategies aim for different neurochemical effects compared to the initial antidepressant.
• Limited controlled data exists, with decisions often based on anecdotal evidence.

Conclusions:

• Augmentation and combination strategies are viable options for TRD and partial responders.
• Further controlled studies are necessary to establish comparative efficacy and tolerability.
• These strategies may be preferred over switching antidepressants due to preserving partial benefits.