Episode 7: Augmentation Strategies for Treatment of Unipolar Depression

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On today’s episode, we will be discussing options for augmentation strategies in the treatment of unipolar depression. For many patients suffering from unipolar major depression, they can continue to suffer from symptoms despite treatment with multiple adequate trials of antidepressants. The decision to add an augmentation agent is one that is most often made in such cases of depression that are what we call “resistant” to treatment.

Generally speaking, there a rough algorithm exists for which steps a clinician should take in treatment a patient with depression that is not responding to initial monotherapy antidepressant treatment.

  1. First, the clinician can consider switching treatment to another antidepressant within the same class or within another class. The clinician can also consider switching treatment to psychotherapy or in the case of patients who have not responded to multiple treatments, possibly switching to electroconvulsive therapy (ECT).
  2. The other option for clinicians to consider is the augmentation of antidepressant monotherapy. This can be done with either another pharmacological agent, with psychotherapy, or with ECT.

In today’s episode, we will focus on pharmacological augmentation agents for treatment resistant unipolar depression. It should be noted, however, that these patients should have a comprehensive treatment plan that includes non-pharmacological interventions, such as psychotherapy, psychoeducation, counseling, and other interventions.

Resources

  1. Sadock, Benjamin James. Sadock, Virginia Alcott. Ruiz, Pedro. Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences/clinical Psychiatry. Philadelphia: Lippincott Williams & Wilkins, 2015. Print.
  2. Warner, Jessica MD, Noah S Phillips MD. “Augmentation Strategies in MDD Therapy.” Psychiatric Times, 10 September 2013. Web. 6 August 2017.
  3. “Augmentation strategies for depression.” Harvard Health Publications, December 2010. Web. 7 August 2017.
  4. Rush, John A MD. “Unipolar depression in adults: Treatment with antidepressant combinations.” UpToDate, 10 January 2017. Web. 7 August 2017.
  5. Gitlin, Michael MD. “Unipolar depression in adults: Augmentation of antidepressants with thyroid hormone.” UpToDate, 18 May 2017. Web. 7 August 2017.
  6. Nierenberg, Andrew MD. “Unipolar major depression in adults: Augmentation of antidepressants with stimulants and stimulant-like drugs.” UpToDate, 9 June 2017. Web. 7 August 2017.
  7. Thase, Michael MD. “Unipolar treatment resistant depression in adults: Epidemiology, risk factors, assessment and prognosis.” UpToDate, 8 March 2017. Web. 8 August 2017.