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Pharmacological Augmentation in Unipolar Depression: A Guide to the Guidelines
Rachael W Taylor1,2, Lindsey Marwood1, Emanuella Oprea1,3
1The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, United Kingdom.
The International Journal of Neuropsychopharmacology
|May 14, 2020
Summary
Pharmacological augmentation for treatment-resistant depression varies across guidelines. Lithium and atypical antipsychotics are commonly recommended, but consistency is needed for evidence-based patient care.
Area of Science:
- Psychiatry
- Clinical Pharmacology
- Evidence-Based Medicine
Background:
- Pharmacological augmentation is crucial for treatment-resistant depression.
- Existing guidelines offer varied advice on treatment selection, potentially impacting evidence-based care.
- Polypharmacy and treatment-resistant depression are linked to side effects and poor outcomes.
Purpose of the Study:
- To provide a definitive overview of pharmacological augmentation recommendations for major depression.
- To assess the quality of depression treatment guidelines.
- To compare recommendations for pharmacological augmentation agents.
Main Methods:
- A systematic literature search identified current depression treatment guidelines.
- Guidelines were assessed for quality using the Appraisal of Guidelines for Research and Evaluation II tool.
- Pharmacological augmentation recommendations were extracted and compared from high-quality guidelines.
Main Results:
- 19 guidelines were assessed, with 10 included in the final analysis.
- Guidelines varied in quality, timing of augmentation, agents recommended, and cited evidence.
- Lithium and atypical antipsychotics were universally recommended, but specific advice lacked consistency.
Conclusions:
- There is a need for greater consistency in pharmacological augmentation guidelines for major depression.
- Guideline variations may stem from publication dates and limited clinical trial evidence.
- Consistent, evidence-based guidance is essential for optimal patient care in treatment-resistant depression.
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