Augmentation strategies for treatment-resistant depression.
OBJECTIVE
The majority of patients with depression fail to remit on one or more antidepressant trials. These patients have treatment-resistant depression (TRD) with high relapsing rates. Augmentation pharmacotherapy refers to the addition of drugs that are not standard antidepressants in order to enhance the effect of a classical antidepressant drug. This review highlights the current status and future research directions of augmentation treatments for TRD with a special focus on research data published within the past year.


RESULTS
Atypical antipsychotics, stimulants, pindolol, lithium, lamotrigine and mecamylamine were tested for efficacy in clinical trials. Most of the trials were not controlled or had limited sample size. Recent data now support the use of some atypical antipsychotics to augment depression resistant to the newer, more selective, antidepressants.


CONCLUSIONS
Lithium and triiodothyronin (T3) augmentation of tricyclic agents remains the best studied strategy. Data converge to demonstrate the efficacy of some atypical antipsychotics as augmenting agents to selective serotonin reuptake inhibitors. Further adequately powered controlled trials on augmentation pharmacotherapy of TRD are necessary.
Carvalho
André F
AF
Department of Clinical Medicine, Psychiatry Outpatient Clinics, Faculty of Medicine, Federal University of Ceara, Fortaleza, Ceara, Brazil. andrefc7@terra.com.br
Machado
Juliana Raulino
JR
Cavalcante
João L
JL
D000928:Antidepressive Agents / Q000008:administration & dosage*; D014150:Antipsychotic Agents / Q000008:administration & dosage; D002065:Buspirone / Q000008:administration & dosage; D000697:Central Nervous System Stimulants / Q000008:administration & dosage; D003866:Depressive Disorder / Q000188:drug therapy*; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D006801:Humans; D018020:Lithium Compounds / Q000008:administration & dosage; D017211:Treatment Failure; D014284:Triiodothyronine / Q000008:administration & dosage
D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D000697:Central Nervous System Stimulants; D018020:Lithium Compounds; D014284:Triiodothyronine; D002065:Buspirone