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Augmentation Strategies for Depression: History and Concepts

Published online by Cambridge University Press:  07 November 2014

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Extract

Depression is one of the world's great public health problems. As there are no perfect or uniformly effective treatments for depression, it is not surprising that treatment-resistant depression (TRD) is likewise an important public health problem. Although the potential benefits of antidepressants are now well documented, no widely used antidepressant can be expected to be effective in more than half the patients who begin to take it. Even under optimal circumstances (ie, a patient who is fully adherent to 12 weeks of treatment), there is only a 60% to 70% chance that the first choice of medication will be effective. The need for effective alternate strategies for TRD, as well as the need for innovations in service delivery systems to ensure those strategies are implemented in a timely manner, are foremost to fully realizing the potential benefits of antidepressant therapies.

Over the years, hierarchies of treatment strategies for TRD have been based on the widespread use of particular treatments, their ease of use, and their safety or complexity. One of the strategies consistently used since its introduction 20 years ago has been augmentation of the ineffective antidepressant by a second medication. The second agent may or may not have antidepressant effects of its own, but when used in combination with a primary antidepressant the agent reliably increases a patient's likelihood of response and symptom remission.

Type
Expert Roundtable Supplement
Information
CNS Spectrums , Volume 12 , Issue S22: Augmentation Strategies in the Treatment of Major Depressive Disorder , December 2007 , pp. 3 - 5
Copyright
Copyright © Cambridge University Press 2007

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References

1.Blackman, B. The adjunctive role of diazepam in the treatment of depression. Clin Med (Northfield II). 1963;70:1495–1500.Google Scholar
2.Hare, HP Jr. Comparison of chlordiazepoxide-amitriptyline combination with amitriptyline alone in anxiety-depressive states. J Clin Pharmacol New Drugs. 1971;11(6):456–460.Google Scholar
3.Feighner, JR, Brauzer, B, Gelenberg, AJ, et al.A placebo-controlled multicenter trial of Limbitrol versus its components (amitriptyline and chlordiazepoxide) in the symptomatic treatment of depressive illness. Psychopharmacology (Berl). 1979;61(2):217–225.Google Scholar
4.Shader, RI, Greenblatt, DJ. Benzodiazepine overuse-misuse. J Clin Psychopharmacol. 1984;4(3):123–124.Google Scholar
5.Robertson, MM, Trimble, MR. Major tranquillisers used as antidepressants. A review. J Affect Disord. 1982;4(3):173–193.Google Scholar
6.Spiker, DG, Weiss, JC, Dealy, RS, et al.The pharmacological treatment of delusional depression. Am J Psychiatry. 1985;142(4):430–436.Google Scholar
7.Mena, A, Heistad, G, Schiele, BC, Janecek, J. A comparison of tranylcypromine alone with tranylcypromine plus trifluoperazine in the treatment of chronic outpatients: a double-blind controlled study. J Neuropsychiatr. 1964;5:542–550.Google Scholar
8.Prange, AJ Jr, Wilson, IC, Rabon, AM, Lipton, MA. Enhancement of imipramine antidepressant activity by thyroid hormone. Am J Psychiatry. 1969;126(4):457–469.Google Scholar
9.Prange, AJ Jr, Wilson, IC, Lipton, MA, Rabon, AM, McClae, TK, Knox, AE. Use of a thyroid hormone to accelerate the action of imipramine. Psychosomatics. 1970;11(5):442–444.Google Scholar
10.Wilson, IC, Prange, AJ Jr, McClane, TK, Rabon, AM, Lipton, MA. Thyroid-hormone enhancement of imipramine in nonretarded depressions. N Engl J Med. 1970;282(19):1063–1067.Google Scholar
11.Altshuler, LL, Bauer, M, Frye, MA, et al.Does thyroid supplementation accelerate tricyclic antidepressant response? A review and meta-analysis of the literature. Am J Psychiatry. 2001;158(10):1617–1622.CrossRefGoogle ScholarPubMed
12.Haggerty, JJ Jr, Stern, RA, Mason, GA, Beckwith, J, Morey, CE, Prange, AJ Jr. Subclinical hypothyroidism: a modifiable risk factor for depression? Am J Psychiatry. 1993;150(3):508–510.Google Scholar
13.Thase, ME, Kupfer, DJ, Jarrett, DB. Treatment of imipramine-resistant recurrent depression: I. An open clinical trial of adjunctive L-triiodothyronine. J Clin Psychiatry. 1989;50(10):385–388.Google Scholar
14.Frye, MA, Denicoff, KD, Bryan, AL, et al.Association between lower serum free T4 and greater mood instability and depression in lithium-maintained bipolar patients. Am J Psychiatry. 1999;156(12):1909–1914.Google Scholar
15.Cole, DP, Thase, ME, Mallinger, AG, et al.Slower treatment response in bipolar depression predicted by lower pretreatment thyroid function. Am J Psychiatry. 2002;159(1):116–121.Google Scholar
16.Gitlin, M, Altshuler, LL, Frye, MA, et al.Peripheral thyroid hormones and response to selective serotonin reuptake inhibitors. J Psychiatry Neurosci. 2004;29(5):383–386.Google ScholarPubMed
17.Himmelhoch, JM, Detre, T, Kupfer, DJ, Swartzburg, M, Byck, R. Treatment of previously intractable depressions with tranylcypromine and lithium. J Nerv Ment Dis. 1972; 155(3):216–220.Google Scholar
18.de Montigny, C, Grunberg, F, Mayer, A, Deschenes, JP. Lithium induces rapid relief of depression in tricyclic antidepressant drug non-responders. Br J Psychiatry. 1981;138:252–256.Google Scholar
19.de Montigny, C, Cournoyer, G, Morissette, R, Langlois, R, Caille, G. Lithium carbonate addition in tricyclic antidepressant-resistant unipolar depression. Correlations with the neurobiologic actions of tricyclic antidepressant drugs and lithium ion on the serotonin system. Arch Gen Psychiatry. 1983;40(12):1327–1334.CrossRefGoogle ScholarPubMed
20.Heninger, GR, Charney, DS, Sternberg, DE. Lithium carbonate augmentation of antidepressant treatment. An effective prescription for treatment-refractory depression. Arch Gen Psychiatry. 1983;40(12):1335–1342.Google Scholar
21.Price, LH, Charney, DS, Heninger, GR. Variability of response to lithium augmentation in refractory depression. Am J Psychiatry. 1986;143(11):1387–1392.Google Scholar
22.Thase, ME, Kupfer, DJ, Frank, E, Jarrett, DB. Treatment of imipramine-resistant recurrent depression: II. An open clinical trial of lithium augmentation. J Clin Psychiatry. 1989b;50(11):413–417.Google Scholar
23.Kupfer, DJ, Pickar, D, Himmelhoch, JM, Detre, TP. Are there two types of unipolar depression? Arch Gen Psychiatry. 1975;32(7):866–871.Google Scholar
24.Thase, ME, Howland, RH, Friedman, ES. Treating antidepressant nonresponders with augmentation strategies: an overview. J Clin Psychiatry. 1998;59(suppl 5):5–12.Google Scholar