To combine or not to combine? A literature review of antidepressant combination therapy.
OBJECTIVE
Treatment resistant depression is a common clinical problem and a major public health concern. The use of antidepressant combinations to overcome treatment resistance, while somewhat controversial, is a popular strategy in practice. This paper reviews published trials on combination antidepressants with a view to inform clinical practice.


METHODS
A systematic but selective review of the published literature was conducted using EMBASE, PSYCHLIT and MEDLINE with relevant search terms.


RESULTS
A number of trials suggesting efficacy of combination antidepressants were found. These are incorporated into a number of treatment guidelines for the management of treatment refractory depression. Clinicians should be cautious regarding pharmacokinetic and pharmacodynamic interactions, including the serotonin syndrome, however combination strategies are an effective option.


CONCLUSIONS
Many antidepressants can be usefully combined especially if they engage separate mechanisms of action. Clinically, antidepressant combinations provide a useful resort in otherwise treatment resistant individuals. However, much further research is needed to determine relative efficacy and determine long term outcome.
Dodd
Seetal
S
Department of Clinical and Biomedical Sciences-Barwon Health, University of Melbourne, Swanston Centre, PO Box 281, Geelong 3220, Victoria, Australia. seetald@barwonhealth.org.au
Horgan
David
D
Malhi
Gin S
GS
Berk
Michael
M
D000928:Antidepressive Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000097:blood / Q000188:drug therapy* / Q000523:psychology; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D019233:Retreatment; D055502:Secondary Prevention
D000928:Antidepressive Agents