Update on augmentation of antidepressant response in resistant depression

Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA.
Current Psychiatry Reports (Impact Factor: 3.24). 01/2006; 7(6):435-40. DOI: 10.1007/s11920-005-0064-x
Source: PubMed


Most patients in acute depression trials fail to achieve remission with antidepressant monotherapy. Many patients seem to require more than one medication to achieve remission or adequate response. Augmentation strategies are commonly used in clinical practice, but most have been poorly studied. In addition, better-studied strategies, such as the use of lithium and thyroid augmentation, have not been well investigated in combination with newer antidepressants. Various novel strategies are being investigated as augmenting agents, including selective dopamine agonists, sex steroids, norepinephrine reuptake inhibitors, glucocorticoid-specific agents, and newer anticonvulsants. We review the status of augmentation strategies in the treatment of depression.

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    • "The most commonly used combination agent is bupropion [75], and though its frequency of such usage probably exceeds the available evidence, there is some support for its role as a combination agent [76]. There are several likely reasons why bupropion is such a common combination agent: it is generally a well-tolerated medication [77], it can provide some benefit in counteracting the sexual side effects of the SSRIs, and its presumed mechanism of action as an indirect norepinephrine agonist and dopamine reuptake blocker is, in theory, an attractive accompaniment to the action of SSRIs [78]. After bupropion, the next most common combination agent is mirtazapine [75]. "
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