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Notes:
- Despite the limited
empirical evidence for the efficacy of augmentation/combination, this
option holds several advantages over the use of substitution after antidepressant
failure. Joffe, 1996:28-29
- Patients who
do not respond to the first antidepressant may achieve clinical
response when the second agent is added.
- The strategy
builds on therapeutic gains obtained with the first antidepressant.
- With substitution,
the patient may lose all the gains they have made when the first
antidepressant is stopped. This may be especially important
in the case of partial responders, where the loss of even limited
gains may be a serious and dangerous setback. Joffe, 1996:29
(1)
- The addition
of a second compound is generally well tolerated and does not
substantially alter the side-effect profile of the initial antidepressant.
Joffe, 1995:8 (1)
- There is a
rapid onset of antidepressant effects.
- Response
may take as few as 2 days or up toí 3 to 6 weeks, which is considerably
shorter than the several weeksí delay that occurs with substitution.
This involves taper of the first drug, washout, and delay in
onset of action of the second drug. Joffe, 1996:29 (1)
- The response
rate is comparable or superior to substitution.
- Response
rates with lithium and perhaps other augmentation strategies
is of the order of 50% to 60%. Joffe, 1996:29 (1)
- Disadvantages
of augmentation/combination compared with substitution may be reduced
compliance and increased side effects as a result of taking two
agents rather than one. Joffe, 1996:29 (1)
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