[Tolerability and efficacy of combined antidepressant therapy].
OBJECTIVE
Utilisation of antidepressant combination and augmentation strategies in management of treatment-resistant depression is very common in spite of have been hardly analysed with clinic and neuropharmacological rigor. The aim of this review is to analyse frequency of utilisation, neurobiological mechanisms involved and clinic results observed, with all combination usually used in clinical practice.


METHODS
A bibliographic research was carried out by means of exhaustive review of scientific database (Medline and NLM), from specific key words. Subsequently we realised a cross with all bibliographic references obtained. Less some casuistical references published in difficult access journals, we have revised all outstanding open or controlled published studies.


CONCLUSIONS
It is remarkable large quantity of casuistic information and lack of controlled studies. Most of combinations are justified and supported by hypothetical neurobiological augmentation mechanisms hardly verified. Some combinations (MAOI+TCA, MAOI+SSRI, TCA+TCA, SSRI+SSRI, SSRI+TCA), bring forward few advantages and important risks, so that it should be inadvisable. Nevertheless combinations using SSRI with another antidepressant, as Maprotiline, Mianserine, Bupropion or Mirtazapine, bring forward positive results and suppose low risks, so that should be recommended in resistant depressions or to reduce response latency.
Gándara Martín
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Hospital General Yagüe, 09006 Burgos.
Agüera Ortiz
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Ferre Navarrete
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Rojo Rodés
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Ros Montalbán
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D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003866:Depressive Disorder / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D004361:Drug Tolerance; D006801:Humans; D008996:Monoamine Oxidase Inhibitors / Q000627:therapeutic use*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
D000929:Antidepressive Agents, Tricyclic; D008996:Monoamine Oxidase Inhibitors; D017367:Selective Serotonin Reuptake Inhibitors