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Notes:
Augmentation of Antidepressants:
Summary
- Antidepressant
nonresponse, partial response and side effects are limitations of monotherapy.
- Antidepressant
switching strategies should be employed in non-responders.
- Augmentation strategies
should be employed in partial responders (20-40%) to SSRI therapy.
- Augmentation with
lithium and thyroid hormone are effective approximately 50% of the time.
Laboratory monitoring is required.
- Combined pindolol
plus antidepressant may accelerate and/or potentiate therapeutic effects
in depression; beta blockers are contraindicated in asthma.
- Pindolol and buspirone,
which act on 5HT1A receptors, have proved clinically effective as augmentation
agents.
- These agents
appear to reverse the SSRI-induced presynaptic suppression of serotonin
neuron firing and serotonin release which causes the delay in onset
of antidepressant effects.
- Open label studies
and case reports suggest that buspirone potentiates the antidepressant
activity of such SSRIs as floxetine, fluvoxamine, and paroxetine; the
TCA clomiprimine; and trazodone. Buspirone has excellent safety profile,
and requires no laboratory testing.
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