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
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
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.
One of the most relevant studies for real-world clinical practice,
the Sequenced Treatment Alternatives to Relieve Depression (STAR*D)
trial, found that both psychotherapy and drugs are about equally
effective as augmentation strategies. More recent clinical trials
have tested dietary supplements as possible augmentation agents,
adding to the options.
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