title: Provide optimized antidepressant monotherapy with multiple drugs before considering antidepressant polypharmacy.
abstract: Many patients with chronic or recurring major depressive disorder have suboptimal responses to the wide range of antidepressant medications available. When confronted with these patients, clinicians may augment the original antidepressant with other medications, including adjunctive treatment with a second or third antidepressant. Although it is a widely-used practice among psychiatrists and primary care physicians in high-income countries, evidence for the benefits of this type of antidepressant polypharmacy is limited. Care should be taken to utilize this approach only after failure of optimized monotherapy with different classes of antidepressants.
authors: Department of Psychiatry and Behavioral Sciences, Emory University, Georgia, United States.
authors: Tammy
authors: T
authors: Saah
authors: Department of Psychiatry and Behavioral Sciences, Emory University, Georgia, United States.
authors: Steven J
authors: SJ
authors: Garlow
authors: Department of Psychiatry and Behavioral Sciences, Emory University, Georgia, United States.
authors: Mark H
authors: MH
authors: Rapaport
keywords: antidepressants; augmentation; major depressive disorder; polypharmacy; treatment-resistant depression
references: J Psychiatr Pract. 2014 Mar;20(2):118-32
references: 24638046
references: Am J Psychiatry. 2006 Sep;163(9):1531-41; quiz 1666
references: 16946177
references: J Am Geriatr Soc. 2011 Jul;59(7):1197-205
references: 21718261
references: Am J Psychiatry. 2011 Jul;168(7):681-8
references: 21454919
references: Arch Gen Psychiatry. 2010 Jan;67(1):26-36
references: 20048220
references: J Affect Disord. 2009 Sep;117(1-2):18-23
references: 19103462
references: CNS Drugs. 2010 Feb;24(2):131-61
references: 20088620
references: Curr Med Res Opin. 2010 Jun;26(6):1343-53
references: 20373875