Antidepressant augmentation and combinations

Although effective, the selective serotonin (5-HT) reuptake inhibitors (SSRIs) and the newer generation of antidepressants are far from perfect; 10% to 30% of depressed patients fail to respond to those therapies, and 12% to 25% respond but fail to remit fully with adequate therapy.(47,55a) After depressed patients fail to respond to adequate antidepressant trials, several treatment strategies can be used, including augmenting the failed antidepressant, combining antidepressants, or switching to another antidepressant.(19,55a) Many agents may augment antidepressants, and combinations of antidepressants also are useful, but data to support these strategies are limited; no available data support one over the other. This article critically reviews augmentation strategies, including lithium, thyroid hormone, stimulants, dopamine agonists and modafinil, buspirone, pindolol, anticonvulsants, atypical antipsychotics, and combinations of antidepressants.(21)