Issues in polypharmacotherapy: focus on major depression

Combination therapy is often used to improve efficacy, speed response, or attenuate an adverse effect of the initial pharmacotherapy. This article examines key issues in the use of polypharmacotherapy in the treatment of major depressive disorders. The addition of lithium and to a lesser extent triiodothyronine T3 have been shown to be effective augmentation strategies in treatment-resistant depression. There is also evidence suggesting that lithium augmentation of tricyclic or serotonergic antidepressants and the combination of a serotonergic and noradrenergic antidepressant may hasten response. Some newer combination strategies in treating major depressive disorders are discussed.