Current Status of Augmentation and Combination Treatments for Major Depressive Disorder: A Literature Review and a Proposal for a Novel Approach to Improve PracticeFava M. · Rush A.J.
aDepression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, Mass., and bUT Southwestern Medical School, Dallas, Tex., USA
Most patients with major depressive disorder (MDD) do not reach symptom remission. These patients with residual symptoms have worse function and worse prognosis than those who remit. Several augmentation and combination treatments are used to either increase the chances of achieving remission or to eliminate/minimize residual depressive symptoms. Evidence for these pharmacological approaches rests primarily on open, uncontrolled studies, and there are clearly not enough controlled studies. Clinicians should carefully weigh these different treatment options to increase their patients’ chances of achieving and sustaining remission from depression. This paper will review the pertinent studies and will propose a novel approach to improve practice involving the use of augmentation or combination strategies at the outset of initial treatment to primarily enhance the chances of remission through synergy and/or a broader spectrum of action. This novel approach could potentially enhance retention and/or increase remission rates since the lack of response with antidepressant monotherapy may lead many depressed patients with little or no benefit to drop out of treatment, precluding the subsequent use of augmentation or combination strategies altogether. In addition, the emergence of certain side-effects (e.g., agitation, insomnia) or the persistence of some initial baseline symptoms (e.g., anxiety, insomnia) may lead to premature discontinuation from monotherapy in the absence of concomitant use of augmenting pharmacological options targeting these symptoms.
Maurizio Fava, MD
Depression Clinical and Research Program, Massachusetts General Hospital
Bulfinch 351-55 Fruit Street
Boston, MA 02114 (USA)
Tel. +1 617 724 0838, Fax +1 617 726 7541, E-Mail MFava@partners.org
Number of Print Pages : 15
Number of Figures : 0, Number of Tables : 0, Number of References : 168
Psychotherapy and Psychosomatics
Vol. 75, No. 3, Year 2006 (Cover Date: April 2006)
Journal Editor: Fava, G.A. (Bologna)
ISSN: 0033–3190 (print), 1423–0348 (Online)
For additional information: http://www.karger.com/PPS