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Augmentation strategies for treatment-resistant depression: a literature review: Augmentation strategies for TRD
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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“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]
In the citing paper
“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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Metadata
- Authors
- Carvalho, A. F., Cavalcante, J. L., Castelo, M. S., & Lima, M. C. O.
- Affiliations
- Universidade Federal do Ceará (BR)
- Henry Ford Health (US)
- 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
- 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
- Locations
- Journal of Clinical Pharmacy and Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology (medical) › 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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