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An Evidence-Based Approach to Augmentation and Combination Strategies for: Treatment-Resistant Depression.

DESIGN, SETTING, PARTICIPANTS
This paper is a review article that collects and synthesizes up-to-date information about the practice of augmenting and combining medications in regards to treatment resistant major depressive disorder. The authors have written the paper in an evidence-based model in order to show the reader where adequate data exists in regards to these strategies. A thorough MEDLINE search was utilized to collect many papers dedicated to this area of study spanning 1989-2005.


MEASUREMENTS
Papers were divided based upon drug intervention and scientific merit, where randomized controlled trials were given the most evidence-based weight and case studies the least.


RESULTS
The literature review data is divided into augmentation and combination strategies in descending order of scientific stringency. For augmentation, lithium, antipsychotic, and thyroid addition has the most empirical support. For combination strategies, heterocyclic addition is the best studied.


CONCLUSION
There is much literature regarding complex medication management of major depression that is generally supportive of this practice. However, much of the literature contains underpowered and uncontrolled studies.