A REVIEW OF THE USE OF AUGMENTATION THERAPY FOR THE TREATMENT OF RESISTANT DEPRESSION - IMPLICATIONS FOR THE CLINICIAN

Objective: To critically review the literature on augmentation therapy in resistant depression in order to assist the clinician to make a re asoned choice, Augmentation therapy is defined as the addition of a se cond agent to an existing antidepressant regimen with the aim of achie ving improved clinical response.Method: The available literature which related specifically to currently popular augmentation strategies in treatment resistant depression for the past 20 years was examined, The scientific evidence supporting the efficacy of these regimens and the ir safety was reviewed. Results: Considerable research on lithium augm entation has been undertaken, and on triiodothyronine augmentation to a lesser degree. A number of other drugs have been trialled as augment ation agents with claims of success; however, most of the evidence sup porting these agents is anecdotal and in the form of case reports, The re are very few well-performed double-blind placebo-controlled studies of augmentation therapy. Conclusions: Because of possible complex pha rmacodynamic and pharmacokinetic interactions, augmentation therapy is not without its potential complications. Lithium augmentation of tric yclic antidepressants can be recommended as a safe and effective strat egy and there is a body of scientific evidence supporting the addition of T-3 as an effective augmentation agent. Recent research with pindo lol augmentation of selective serotonin re-uptake inhibitors (SSRIs) i s encouraging, but these findings require replication, There is no emp irical evidence supporting buspirone, carbamazepine, sodium valproate, methylphenidate or amphetamine as effective augmentation agents, or t hat adding a tricyclic to a SSRI has usefulness in relieving depressiv e symptoms, There is a need for considerable research in this area, wi th more prospective well-controlled placebo studies.