Unipolar depression in adults: Treatment with antidepressant combinations
- John A Rush, MD
John A Rush, MD
- Professor Emeritus
- National University of Singapore, Duke-NUS
Antidepressant combinations are generally used for unipolar major depression (major depressive disorder) that is resistant to treatment with antidepressant monotherapy. Add-on pharmacotherapy is often necessary because initial treatment with a single antidepressant leads to remission in only 30 to 50 percent of patients [1-3]. Options for adjunctive pharmacotherapy include a second antidepressant, as well as second-generation antipsychotics, lithium, and triiodothyronine. Adjunctive psychotherapy is also an option.
Combining two antidepressants for treatment resistant depression is common . As an example, retrospective studies of patients treated for depression with a single antidepressant (insurance claims database n >134,000; registry database n >240,000) found that a second antidepressant was added in approximately 10 percent of patients [5,6].
This topic reviews the indications and efficacy of combining antidepressants for patients with unipolar, nonpsychotic major depression. Choosing a drug regimen for major depression and using a second antidepressant as a hypnotic are discussed separately. (See "Unipolar depression in adults: Treatment of resistant depression" and "Unipolar major depression in adults: Choosing initial treatment" and "Treatment of insomnia in adults", section on 'Antidepressants'.)
Indications for antidepressant combinations include:
●Unipolar major depression that does not respond to multiple courses of treatment with antidepressant monotherapy as well as an antidepressant plus adjunctive pharmacotherapy (eg, antidepressant plus a second-generation antipsychotic, lithium, or triiodothyronine). (See "Unipolar depression in adults: Treatment of resistant depression", section on 'Choosing a drug'.)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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