Treatment of antidepressant nonresponders: augmentation or switch?

Selective serotonin reuptake inhibitors (SSRIs) are now commonly used in the treatment of major depression. In all patients starting treatment, the intent-to-treat response rate is about 50%. The other 50% will require some change in treatment, either augmentation or switch to a different agent. In this report, augmentation strategies are reviewed, with special attention to those strategies that have been used with the SSRIs. The data for switching antidepressants also are reviewed. Although there are no direct comparison studies of augmentation strategies versus switching that address the question of relative efficacy, the tactical issues that pertain to augmentation or switching are discussed.