[Augmentation strategies for therapy resistant depression - a review].
OBJECTIVE
Various pharmacological strategies have been developed to treat such refractory depression, of which augmentation therapies are one of the most important. This article reviews both benefits and risks of all known augmentation therapies.


METHODS
The relevant literature was identified by means of a computerized MEDLINE research on the years 1990 - 2004 and scanning of review articles.


RESULTS
The efficacy of lithium augmentation is very well documented by a large number of controlled studies - lithium augmentation can therefore be recommended in depression refractory to antidepressant treatment. T3 augmentation is - in contrast to lithium augmentation - only a second-line strategy. There is an increasing number of augmentation therapies with atypical antipsychotics - its efficacy already supported by some well designed placebo controlled studies. Augmentation strategies with buspirone, modafinil and dopaminergic agents show good results in some case series and open studies, but there is a lack of doubleblind placebo controlled studies till now. Other augmentation therapies with stimulants, reserpine, pindolol, SAME and Yohimbine are very interesting clinical research strategies with rather little impact on clinical practice at the moment.


CONCLUSIONS
The distinct knowledge of available augmentation strategies may help to increase response - as well as remission rates in therapy resistant depression.
Schmauss
Max
M
Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Augsburg. m.schmauss@bkh-augsburg.de
Messer
Thomas
T
D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001559:Benzhydryl Compounds / Q000009:adverse effects / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004347:Drug Interactions; D018432:Drug Resistance, Multiple; D004359:Drug Therapy, Combination; D006801:Humans; D018020:Lithium Compounds / Q000009:adverse effects / Q000627:therapeutic use; D000077408:Modafinil; D014284:Triiodothyronine / Q000009:adverse effects / Q000627:therapeutic use
D000928:Antidepressive Agents; D001559:Benzhydryl Compounds; D018020:Lithium Compounds; D014284:Triiodothyronine; D000077408:Modafinil