title: Comparing augmentation with non-antidepressants over sticking to antidepressants after treatment failure in depression: a naturalistic study.
abstract: BACKGROUND
  Non-response to an antidepressant monotherapy in unipolar depression is quite common. Therefore strategies for subsequent treatment steps are necessary. However, there is a lack of direct comparisons of these different strategies. In this naturalistic study we compared the outcome to different strategies after failure of the primary antidepressant treatment.
  
  
  METHODS
  Failure of primary antidepressant monotherapy occurred in 135 patients. 98 of these patients have been administered 4 treatment strategies of the physicians' choice: lithium augmentation (Li-Augm), switching to another antidepressant (AD-Switch), combination of 2 antidepressants (AD-Comb) or augmentation with second generation antipsychotic (SGA-Augm). Primary outcome measure was the 17-item Hamilton rating scale for depression (HRSD).
  
  
  RESULTS
  Patients who received Li-Augm or augmentation with SGAs showed significantly greater improvement in HRSD and BDI compared to patients with antidepressant switch or antidepressant combination. Remission rates for Li-Augm and SGA-Augm were 89.3% and 86.2% compared to 40.7% for AD-Switch and 42.9% for AD-Comb.
  
  
  CONCLUSIONS
  Changing to another pharmacological class (Li-Augm or augmentation with SGAs) showed better treatment results than sticking to the class of antidepressants (AD-Switch and AD-Comb) after primary failure in response to antidepressant monotherapy in unipolar depression. The lack of randomization and absence of a non-response definition are design flaws. Controlled studies are required to confirm the findings of this trial.
authors.affiliation: Department of Psychiatry, Charité University Medicine Berlin, Campus Mitte, Berlin, Germany. stephan.koehler@charite.de
authors.forename: S
authors.initials: S
authors.lastname: Köhler
authors.forename: T
authors.initials: T
authors.lastname: Unger
authors.forename: S
authors.initials: S
authors.lastname: Hoffmann
authors.forename: B
authors.initials: B
authors.lastname: Steinacher
authors.forename: T
authors.initials: T
authors.lastname: Fydrich
authors.forename: T
authors.initials: T
authors.lastname: Bschor
mesh_terms: D000928:Antidepressive Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D061218:Depressive Disorder, Treatment-Resistant / Q000188:drug therapy*; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005260:Female; D006801:Humans; D018020:Lithium Compounds / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D018020:Lithium Compounds