Combining Meds for Depression: The State of The Art
In surveys, it’s clear that most psychiatrists practice as unimaginatively as I typically do, meaning that their drug of first choice for most depressed patients is an SSRI (Petersen T, et al., Prog Neuropsychopharmacol Biol Psychiatry 2002; 26:177-187). If SSRIs don’t work, there are various options. Optimization, or raising the dose, is one option, and is covered in another article in this issue. Many of us will eventually move on to a combination/augmentation strategy. But it's becoming increasingly difficult to know which combinations to use. The evidence becomes murkier with each new study. Here’s a brief, selective run-down of the state of the art.
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Ronald C. Albucher, MD, is the director of counseling and psychological services and clinical assistant professor of psychiatry, Stanford University in Palo Alto, CA.
Steve Balt, MD is a psychiatrist in private practice in the San Francisco Bay area.
Richard Gardiner, MD, is a psychiatrist in private practice in Potter Valley, CA.
Alan D. Lyman, MD, is a child and adolescent psychiatrist in private practice in New York City, NY.
James Megna, MD, PhD, is the director of inpatient psychiatry and an associate professor of psychiatry and medicine at SUNY Upstate Medical University in Syracuse, NY.
Robert L. Mick, MD, is a contract physician in addiction medicine and military psychiatry in Bloomfield, NY.
Michael Posternak, MD, is a psychiatrist in private practice in Boston, MA.
Glen Spielmans, PhD, is an assistant professor of psychology at Metropolitan State University in St. Paul, MN.
Marcia L. Zuckerman, MD is director of Psychiatric Services at Walden Behavioral Care in Waltham, MA.
All editorial content is peer reviewed by the editorial board. Dr. Albucher, Dr. Balt, Dr. Gardiner, Dr. Goldberg, Dr. Lyman, Dr. Megna, Dr. Mick, Dr. Posternak, Dr. Spielmans, and Dr. Zuckerman have disclosed that they have no relevant financial or other interests in any commercial companies pertaining to this educational activity. Dr. Balt discloses that his spouse is employed as a sales representative for Otsuka America, Inc.