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2. Strategies: Combination and Augmentation
Prof. Philip Cowen
Professor of Psychopharmacology
Department of Psychiatry
University of Oxford, UK

3. If no response to antidepressant switch
Combination
Using two drugs
Better effect than if either were given alone
Current treatment + second agent
Antidepressant

4. If no response to antidepressant switch
Combination
Using two drugs
Better effect than if either were given alone
Current treatment + second agent
Antidepressant

5. 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

6. 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.

7. 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.

8. 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.

9. Key Points Adding a second drug in combination or augmentation
Slightly more effective and faster than a switch in treatment

10. 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

11. Next Presentation: Antidepressant Combinations