Augmentation of standard depression therapy.
OBJECTIVE
This article reviews treatment options (eg, augmentation) for depressed patients with suboptimal clinical responses to an antidepressant.


BACKGROUND
Approximately one third of patients treated with antidepressants exhibit suboptimal or delayed clinical response to these medications. In such cases, alternative options include switching to another antidepressant or adding a second antidepressant. Augmentation strategies include addition of lithium carbonate, atypical antipsychotics, psychostimulants, thyroid hormone (triiodothyronine), pindolol, or buspirone.


CONCLUSIONS
In approximately half of all antidepressant-resistant cases of major depressive disorder, controlled clinical trials have indicated that augmentation with lithium or thyroid hormone is effective. Other reports suggest that central nervous system stimulants may augment antidepressant activity, but their use is constrained by possible abuse potential. Pindolol therapy has been shown to accelerate clinical response in some but not all studies. Finally, the favorable safety and tolerability profile of buspirone, together with its desirable anxiolytic effects, render it a sound therapeutic option in antidepressant augmentation.
Marangell
L B
LB
Department of Psychiatry, Baylor College of Medicine, Houston, Texas 77030, USA.
D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018849:Controlled Clinical Trials as Topic; D003866:Depressive Disorder / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D006801:Humans; D008094:Lithium / Q000008:administration & dosage / Q000627:therapeutic use; D013963:Thyroid Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome
D000928:Antidepressive Agents; D013963:Thyroid Hormones; D008094:Lithium