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Provide optimized antidepressant monotherapy with multiple drugs before considering antidepressant polypharmacy
Tammy Saah1, Steven J Garlow1, Mark H Rapaport1
1Department of Psychiatry and Behavioral Sciences, Emory University, Georgia, United States.
Shanghai Archives of Psychiatry
|February 3, 2015
Summary
For major depressive disorder, adding more antidepressants (antidepressant polypharmacy) is common but lacks strong evidence. This strategy should only be used after trying single antidepressant treatments first.
Area of Science:
- Psychiatry
- Pharmacology
- Clinical Medicine
Background:
- Major depressive disorder (MDD) often shows poor response to standard antidepressant monotherapy.
- Treatment resistance is a significant challenge in managing chronic or recurrent MDD.
- Antidepressant polypharmacy, using multiple antidepressants concurrently, is a common clinical practice.
Purpose of the Study:
- To evaluate the evidence base for adjunctive antidepressant polypharmacy in MDD.
- To inform clinical decision-making regarding the use of multiple antidepressants.
Main Methods:
- Review of existing literature on antidepressant polypharmacy for MDD.
- Analysis of clinical guidelines and expert opinions.
Main Results:
- Limited empirical evidence supports the efficacy of adjunctive antidepressant polypharmacy.
- The practice is widespread, particularly in high-income countries.
- No clear guidelines exist for its optimal application.
Conclusions:
- Antidepressant polypharmacy for MDD lacks robust supporting evidence.
- This approach should be reserved for cases where optimized monotherapy has failed.
- Further research is needed to establish the benefits and risks of combining antidepressants.
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