title: Combined antidepressants: clinical experience.
abstract: OBJECTIVE
  To review the current literature on the use of combinations of antidepressive agents.
  
  
  METHODS
  Literature searches were undertaken and reviewed on the use of combinations of antidepressants.
  
  
  RESULTS
  Data sources included surveys, analyses of prescription records, decision algorithms, clinical reports, and studies comparing the monotherapy with combination therapy. More recent surveys recommend combining different selective serotonin reuptake inhibitors (SSRIs), an SSRI plus bupropion or dual action antidepressants plus an SSRI. Decision algorithms recommend an SSRI plus tricyclic antidepressant (TCA) and more recently bupropion plus venlafaxine or mirtazapine. Few controlled clinical trials comparing the combined therapy with monotherapy have been conducted. Beneficial effects have been reported with combinations of TCAs plus mianserin or SSRIs plus mirtazapine.
  
  
  CONCLUSIONS
  Adding or combining antidepressant medications has advantages for the speed of onset and maintaining the existing response. More rigorous clinical trials comparing combination therapy with monotherapy and for the development of rational treatment guidelines are required.
authors.affiliation: Hospital Universitàri de Bellvitge, L'Hospitalet de Llobregat, Madrid, Spain. jrojo@csub.scs.es
authors.forename: J E
authors.initials: JE
authors.lastname: Rojo
authors.forename: S
authors.initials: S
authors.lastname: Ros
authors.forename: L
authors.initials: L
authors.lastname: Agüera
authors.forename: J
authors.initials: J
authors.lastname: de la Gándara
authors.forename: J M
authors.initials: JM
authors.lastname: de Pedro
mesh_terms: D000465:Algorithms; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D003625:Data Collection; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011570:Psychiatry / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents