Antidepressant augmentation

In patients with treatment-resistant major depression, psychiatrists may combine an antidepressant with one of the following drugs:

  • lithium—lithium augmentation has mainly been studied with tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs), but may be considered for all antidepressants. Response rates of up to 50% have been reported in patients receiving lithium augmentation of selective serotonin reuptake inhibitors (SSRIs) or TCAs. Monitor lithium blood concentration; the target concentration for this indication is 0.4 to 0.6 mmol/L12
  • liothyronine (T3)
  • an antipsychotic—aripiprazole, brexpiprazole, cariprazineNunez 2022Sachs 2023, olanzapine and quetiapine have the most evidence; however, only quetiapine is approved for this indication. Before an antipsychotic is started, baseline tests are required (see Baseline parameters potentially affected by antipsychotic therapy). For a schedule of ongoing monitoring of antipsychotic adverse effects, see ../Antipsychotic-adverse-effects/c_ptg8-c73-s1.html#ptg8-c73-s1__tptg8-c73-tbl4.
1 A list of Australian laboratory test databases is available at the Australasian Association for Clinical Biochemistry and Laboratory Medicine (AACB) ‘Testing for health’ website.Return
2 For information on therapeutic reference ranges of psychotropics, see Hiemke C, Bergemann N, Clement HW, Conca A, Deckert J, Domschke K, et al. Consensus guidelines for therapeutic drug monitoring in neuropsychopharmacology: update 2017. Pharmacopsychiatry 2018;51(1-02):9-62. [URL]Return