Past Issues

Drug Augmentation for Treatment-refractory Major Depressive Disorder

Cynthia Yi-An Chen, Yi-Hang Chiu, Winston W. Shen

Major depressive disorder (MDD) is one of the most frequent psychiatric diseases seen in the clinic. Most MDD patients can be treated reliably and comfortably with the use of one antidepressant. But some patients have treatment-refractory depression (TRD), which needs to be managed with switch of the antidepressant or augmentation therapy with another antidepressant or other drugs. Therefore, managing TRD is a challenge for practicing psychiatrists. In this overview, the authors are focusing on treating TRD with augmentation therapy. First, clinicians need to be well-versed in behavioral and physiological classifi cation of antidepressants as a logical basis of choosing an appropriate antidepressant for add-on therapy. Second, clinicians need to be familiarized with data of clinical drug trials for treating TRD with second-generation antipsychotic drugs such as aripiprazole, olanzapine, and quetiapine, approved by the Food and Drug Administration (FDA) of the United States. Third, clinicians need to recognize the use of lithium and thyroid hormone as an add-on drugs for treating patients with TRD. Finally, the patients need to be educated to adapt a healthy lifestyle such as having the habit of regular aerobic exercise, refraining from substance uses, etc. With all those tips, the authors believe that the goal of remission can be more easily achieved for patients with TRD.
Key Word a second antidepressant, second generation antipsychotic drugs, lithium, thyroid hormone
Editorial Committe, Taiwanese Journal of Psychiatry
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