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Related Experiment Videos

Augmentation and combination strategies for depression.

Charles DeBattista1

  • 1Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA 94305, USA. debattista@stanford.edu

Journal of Psychopharmacology (Oxford, England)
|April 29, 2006
PubMed
Summary

Treatment-resistant depression is common, with many patients not fully responding to antidepressants. Evidence supports lithium and thyroid hormone augmentation, while other popular strategies lack robust controlled study data.

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Area of Science:

  • Psychiatry
  • Pharmacology
  • Clinical Medicine

Background:

  • Treatment-resistant depression (TRD) affects a majority of patients with depression, leading to incomplete response to standard antidepressant therapies.
  • Augmentation and combination strategies are frequently used for TRD, yet evidence-based guidance for treatment selection is limited.
  • Many commonly used augmentation strategies lack rigorous, randomized controlled trial (RCT) data.

Purpose of the Study:

  • To review the existing evidence for commonly utilized augmentation strategies in treatment-resistant depression.
  • To evaluate the controlled study data supporting the efficacy of various augmentation agents.
  • To explore emerging or investigational approaches for managing TRD.

Main Methods:

  • Systematic review and evidence synthesis of randomized, controlled studies.

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  • Analysis of controlled data for common augmentation agents including bupropion, psychostimulants, atypical antipsychotics, lithium, and thyroid hormone.
  • Exploration of preliminary data for novel treatment strategies.

    • Main Results:

    • Popular augmentation strategies like bupropion, psychostimulants, and atypical antipsychotics have limited supporting evidence from controlled studies.
    • Lithium and thyroid hormone augmentation demonstrate substantial evidence from controlled studies, despite less frequent clinical use.
    • The paper identifies gaps in evidence and highlights areas for future research in TRD management.

    Conclusions:

    • The choice of augmentation strategies for treatment-resistant depression should be guided by robust evidence, favoring agents with strong controlled study support.
    • Clinicians should critically evaluate the evidence base for commonly prescribed augmentation agents.
    • Further research is needed to establish evidence for popular but less-studied augmentation options and novel approaches.