Beyond the evidence: Is there a place for antidepressant combinations in the pharmacotherapy of depression?

Abstract

• Up to 45% of patients with debilitating and potentially lethal depressive illness do not achieve remission with initial drug treatment. • Using combinations of antidepressants as an early option for treatment-resistant depression has become increasingly common. • Before trying combination therapy, it is essential first to ensure diagnosis is correct, and then to optimise antidepressant monotherapy, using an effective dose for an adequate period. • Subsequently, augmentation of antidepressants with lithium and triiodothyronine should be considered, as these strategies are strongly supported by numerous clinical trials. Electroconvulsive therapy is the most effective treatment for severe dep..