Harvard Mental Health Letter

Augmentation strategies for depression

Options include psychotherapy, drugs, and dietary supplements.

Only one-third of adult patients newly diagnosed with major depression achieve complete relief of symptoms after taking one antidepressant. These remission rates apply even when patients take "newer" antidepressants such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs).

When a first drug fails, three next-step options exist: switching to a new medication, augmenting the first drug with one that acts in a different way, or augmenting drug treatment with psychotherapy.

Augmentation is generally considered the best option when a first drug provides partial relief but does not completely alleviate symptoms. Disadvantages of this strategy include cost of additional treatment and (if drug augmentation is used) increased likelihood of side effects and drug interactions.

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