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Strategies: Combination and Augmentation Prof. Philip Cowen Professor of Psychopharmacology Department of Psychiatry University of Oxford, UK
If no response to antidepressant switch Combination Using two drugs Better effect than if either were given alone Current treatment + second agent Antidepressant
If no response to antidepressant switch Combination Using two drugs Better effect than if either were given alone Current treatment + second agent Antidepressant
If no response to antidepressant switch Augmentation Adding a second drug Not an antidepressant by itself Can produce an antidepressant effect when added to an ineffective antidepressant E.g.: Lithium
Combination / Augmentation Advantages Disadvantages More effective if patients had a partial response Gaynes BN, Dusetzina SB, Ellis AR, et al (2012) Treating depression after initial treatment failure: directly comparing switch and augmenting strategies in STAR*D. Journal of Clinical Psychopharmacology, 32: 114–9.
Combination / Augmentation Advantages Disadvantages More effective if patients had a partial response Effects of the first treatment are not lost Gaynes BN, Dusetzina SB, Ellis AR, et al (2012) Treating depression after initial treatment failure: directly comparing switch and augmenting strategies in STAR*D. Journal of Clinical Psychopharmacology, 32: 114–9.
Combination / Augmentation Advantages Disadvantages More effective if patients had a partial response Side effects Effects of the first treatment are not lost Drug-drug interactions Gaynes BN, Dusetzina SB, Ellis AR, et al (2012) Treating depression after initial treatment failure: directly comparing switch and augmenting strategies in STAR*D. Journal of Clinical Psychopharmacology, 32: 114–9.
Key Points Adding a second drug in combination or augmentation Slightly more effective and faster than a switch in treatment
Key Points Adding a second drug in combination or augmentation Slightly more effective and faster than a switch in treatment Greater risk of side effects and drug interactions
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