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Augmentation Strategies

Published online by Cambridge University Press:  07 November 2014

Michael E. Thase
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Extract

When patients do not respond to an initial course of antidepressant treatment, clinicians may opt for a number of alternatives. First, re-evaluating the diagnosis to make sure that no comorbidities were missed, and that the diagnosis of major depressive disorder (MDD) is accurate, particularly with respect to recognition of clinical features that might suggest previously unrecognized bipolarity or psychotic features. Secondly, clinicians should ensure that the patient has adhered to the recommended medication. When finally reaching the point of certainty or near certainty that the patient has not benefited from a truly adequate course of treatment lasting ≥8 weeks, the next major considerations usually are to either switch antidepressants or to augment the original choice of treatments. Lastly, selection of the most appropriate “next choice” strategy should take into account the tolerability of and degree of improvement observed with the initial antidepressant medications. Many clinicians prefer to switch patients who have poorer tolerability and minimal symptom improvement and try to augment therapy when the initial antidepressant has been well tolerated and resulted in some degree of symptom improvement.

Information

Type
Expert Panel Supplement
Information
CNS Spectrums , Volume 14 , Issue S4: Pharmacologic and Therapeutic Strategies in Treatment-Resistant Depression , March 2009 , pp. 7 - 10
Copyright
Copyright © Cambridge University Press 2009

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