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Pharmacopsychiatry 2013; 46(02): 69-76
DOI: 10.1055/s-0032-1323677
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

Comparing Augmentation with Non-Antidepressants over Sticking to Antidepressants after Treatment Failure in Depression: A Naturalistic Study

S. Köhler   *
1   Department of Psychiatry, Charité University Medicine Berlin, Campus Mitte, Berlin, Germany
,
T. Unger   *
2   Department of Psychiatry and Psychotherapy, Kliniken im Theodor-Wenzel-Werk, Berlin, Germany
,
S. Hoffmann   *
2   Department of Psychiatry and Psychotherapy, Kliniken im Theodor-Wenzel-Werk, Berlin, Germany
,
B. Steinacher   *
3   Department of Psychiatry and Psychotherapy, Vivantes Wenckebach-Klinikum, Berlin, Germany
,
T. Fydrich   *
4   Department of Psychology, Humboldt-University, Berlin, Germany
,
T. Bschor   *
5   Department of Psychiatry, Schlosspark-Klinik, Berlin, Germany and Department of Psychiatry, University Hospital, Technical University Dresden, Dresden, Germany
› Author Affiliations
Further Information

Publication History

received 24 December 2011
revised 16 July 2012

accepted 24 July 2012

Publication Date:
23 October 2012 (online)

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Abstract

Introduction:

Non-response to an antidepressant monotherapy in unipolar depression is quite common. Therefore strategies for subsequent treatment steps are necessary. However, there is a lack of direct comparisons of these different strategies. In this naturalistic study we compared the outcome to different strategies after failure of the primary antidepressant treatment.

Methods:

Failure of primary antidepressant monotherapy occurred in 135 patients. 98 of these patients have been administered 4 treatment strategies of the physicians’ choice: lithium augmentation (Li-Augm), switching to another antidepressant (AD-Switch), combination of 2 antidepressants (AD-Comb) or augmentation with second generation antipsychotic (SGA-Augm). Primary outcome measure was the 17-item Hamilton rating scale for depression (HRSD).

Results:

Patients who received Li-Augm or augmentation with SGAs showed significantly greater improvement in HRSD and BDI compared to patients with antidepressant switch or antidepressant combination. Remission rates for Li-Augm and SGA-Augm were 89.3% and 86.2% compared to 40.7% for AD-Switch and 42.9% for AD-Comb.

Discussion:

Changing to another pharmacological class (Li-Augm or augmentation with SGAs) showed better treatment results than sticking to the class of antidepressants (AD-Switch and AD-Comb) after primary failure in response to antidepressant monotherapy in unipolar depression. The lack of randomization and absence of a non-response definition are design flaws. Controlled studies are required to confirm the findings of this trial.

Key words

depression - depression treatment - antidepressants
*

* All authors contributed to and have approved the final manuscript


 

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