Does increasing dose improve efficacy in patients with poor antidepressant response: a review

Objective: Therapeutic strategies in depressed patients with no or partial response to adequate first-line antidepressant medication remain a matter of concern. This paper focuses on the strategy of dose increase. Method: This review was based on a systematic Medline search of papers dealing with antidepressant dose issues in major depression since the 1960s. Results: The strategy of dose increase is poorly studied in clinical trials. Conclusion: Until this strategy is better studied, caution is advised in its use. However, antidepressants for which this strategy seems tio be the most relevant are tricyclic drugs and serotonin and noradrenaline reuptake inhibitors. These results are discussed both in terms of therapeutic strategies for the clinician and in terms of clinical research.