Tolerability and efficacy of combined antidepressant therapy

Abstract

Objectives. Utilisation of antidepressant combination and augmentation strategies in management of treatmentresistant depression is very common in spite of have been hardly analysed with clinic and neuropharmacological rigor. The aim of this review is to analyse frequency of utilisation, neurobiological mechanisms involved and clinic results observed, with all combination usually used in clinical practice.

Methodology. A bibliographic research was carried out by means of exhaustive review of scientific database (Medline and NLM), from specific key words. Subsequently we realised a cross with all bibliographic references obtained. Less some casuistical references published in difficult access journals, we have revised all outstanding open or controlled published studies.

Conclusions. It is remarkable large quantity of casuistic information and lack of controlled studies. Most of combinations are justified and supported by hypothetical neurobiological augmentation mechanisms hardly verified. Some combinations (MAOI+TCA, MAOI+SSRI, TCA+TCA, SSRI+SSRI, SSRI+TCA), bring forward few advantages and important risks, so that it should be inadvisable. Nevertheless combinations using SSRI with another antidepressant, as Maprotiline, Mianserine, Bupropion or Mirtazapine, bring forward positive results and suppose low risks, so that should be recommended in resistant depressions or to reduce response latency.