Augmentation strategies for treatment-resistant depression: a literature review: Augmentation strategies for TRD

Carvalho, A. F.; Cavalcante, J. L.; Castelo, M. S.; Lima, M. C. O.

doi:10.1111/j.1365-2710.2007.00846.x

Cited by 110Treatment of Major DepressionElectroconvulsive Therapy StudiesBipolar Disorder and Treatment

Augmentation strategies for treatment-resistant depression: a literature review: Augmentation strategies for TRD

Carvalho, A. F., Cavalcante, J. L., Castelo, M. S., Lima, M. C. O.·2007·Journal of Clinical Pharmacy and Therapeutics

DOI 10.1111/j.1365-2710.2007.00846.x

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Abstract

BACKGROUND: The large majority of depressed patients fail to remit on the first antidepressant prescribed. These patients with residual symptoms have higher relapse rates and poorer outcomes than those who remit. Treatment-resistant depression (TRD) is a therapeutic challenge for the clinician. Augmentation pharmacotherapy refers to the addition of drugs that are not standard antidepressants in order to enhance the effect of a classical antidepressant drug. The aim of this paper was to review the available evidence on the various augmenting agents that have been tested for efficacy in TRD. METHODS: Electronic databases and relevant textbooks were searched and the information retrieved was integrated in this review. RESULTS: Although augmentation strategies have been tested with various pharmacological agents, there are few controlled studies published. Lithium, triiodothyronine (T3), buspirone and pindolol have been most widely studied. Other agents include dopaminergic agents, atypical antipsychotics, psychostimulants, benzodiazepines/hypnotics, hormones and anticonvulsants. CONCLUSION: The augmentation therapy with the best evidence was the lithium-antidepressant combination, especially in patients not responding to tricyclic agents. However, good results have also been reported with augmentation strategies involving T3 and buspirone.

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Many patients with major depressive disorder do not reach premorbid levels of psychosocial functioning, such that a significant proportion present residual symptoms.
“Only a subset of individuals with MDD (30–40 %) reach symptomatic remission after adequate treatment with a first-line antidepressant, and many patients do not reach premorbid levels of psychosocial functioning, such that a significant proportion of patients present residual symptoms.”
From Cognitive remission: a novel objective for the treatment of major depression? (2016) · cites this paper as [12]
A significant proportion of patients with major depressive disorder do not recover baseline levels of psychosocial functioning even when they meet the conventional definition of remission.
“In addition, a significant proportion of patients with MDD do not recover baseline levels of psychosocial functioning even when they meet the conventional definition of remission (e.g. a score ≤7 on the Hamilton Depression Rating Scale (HDRS)) [2, 11, 12], suggesting that non-affective dimensions and domains are critical determinants of functional outcome.”
From Cognitive remission: a novel objective for the treatment of major depression? (2016) · cites this paper as [12]

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Pharmacologic alternatives to antidepressants in posttraumatic stress disorder: A systematic review
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Authors: Carvalho, A. F., Cavalcante, J. L., Castelo, M. S., & Lima, M. C. O.
Affiliations: Universidade Federal do Ceará (BR)
Henry Ford Health (US)
ORCID: Carvalho, A. F.
Cavalcante, J. L.
Lima, M. C. O.
Venue: Journal of Clinical Pharmacy and Therapeutics
Publisher: Wiley
Published: 2007-09-14
Volume: 32
Issue: 5
Pages: 415-428
ISSN: 0269-4727 (ISSN-L)
1365-2710
DOI: 10.1111/j.1365-2710.2007.00846.x
OpenAlex: W1623415077
Cited by: 110
References: 176
Citations by year: 2026: 1 · 2025: 1 · 2024: 7 · 2023: 3 · 2022: 7 · 2021: 5 · 2020: 4 · 2019: 8 · 2018: 2 · 2017: 3 · 2016: 8 · 2015: 6 · 2014: 10 · 2013: 12 · 2012: 10
FWCI: 0.77
Type: journal article
Language: en
Open access: closed
Licence: doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 2909 d)
Locations: Journal of Clinical Pharmacy and Therapeutics (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Keywords: treatment-resistant depression, augmentation therapy, antidepressant augmentation, lithium, triiodothyronine, buspirone, pindolol, atypical antipsychotics, psychostimulants, benzodiazepines, antiepileptic drugs, tricyclic antidepressants, residual depressive symptoms
MeSH terms: Central Nervous System Stimulants, Anticonvulsants, Antidepressive Agents, Benzodiazepines, Buspirone, Depressive Disorder, Drug Resistance, Drug Synergism, Drug Therapy, Combination, Humans, Hypnotics and Sedatives, Pindolol, Antipsychotic Agents, Triiodothyronine, Dopamine Agents, Lithium Compounds

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Augmentation strategies for treatment-resistant depression: a literature review: Augmentation strategies for TRD

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