Some patients treated with antidepressants experience only partial improvement. If depression does not improve with monotherapy--single drug treatment--doctor sometimes recommend using two or more medications.
A study examining Sequenced Treatment Alternatives to Relieve Depression--STAR*D--showed "only about 30 percent of patients achieved clinical remission" from depression, according to M.H. Trivedi, A.J. Rush and S.R. Wisniewski's article, "Evaluation of Outcomes with Citalopram for Depression Using Measurement-based Care in STAR*D: Implications for Clinical Practice."
SSRIs and Anti-Psychotic Drugs
Augmentation means taking an antidepressant along with a drug used for a different mental health condition. Some clinicians recommend augmenting selective serotonin reuptake inhibitors, known as SSRIs, with antipsychotic drugs. Vanderbilt University's William V. Bobo, M.D. and Richard C. Shelton, M.D. studied and wrote about patients who had inadequate responses to antidepressant monotherapy but showed improvement after being given the combination of the SSRI, fluoxetine, with an atypical antipsychotic drug, olanzapine. The study's results suggest that there is "evidence supporting the short-term effectiveness of atypical antipsychotic augmentation of antidepressants," in some cases of Major Depressive Disorder.
In the future, similar drug combinations could offer relief to patients suffering from depression, anxiety and panic disorders, obsessive-compulsive disorder and post-traumatic stress disorder.
Bupropion and SSRIs
Bupropion, an antidepressant that affects the neurotransmitter dopamine, does not fit into any specific drug type. Drs. Lam, Hossie, Solomons and Yatham of the University of British Columbia's Department of Psychiatry compared the effects of combining citalopram, an SSRI, with bupropion-SR, versus switching treatment-resistant patients from one drug to another. The results of this study suggest that combining citalopram and bupropion-SR is more effective than switching to a monotherapy and that "the combination treatment was well tolerated with no greater side effect burden than monotherapy."
Combining an SSRI with an SNRI
Combination treatment means different types of antidepressants are prescribed simultaneously, the goal being for the drugs to work on a range of brain chemicals that affect mood. For instance, a psychiatrist or doctor may prescribe both a selective serotonin reuptake inhibitor--SSRI--and a norepinephrine and dopamine reuptake inhibitor--SNRI--to target several neurotransmitters, including dopamine, serotonin and norepinephrine. Serotonin and norepinephrine reuptake inhibitors are similar to selective serotonin reuptake inhibitor and include venlafaxine, duloxetine and desvenlafaxine.
SSRIs and SNRIs are often recommended because they do not have as many side effects as older classes of antidepressants, including tricyclics, tetracyclics, and monoamine oxidase inhibitors, but for some individuals the older antidepressants may actually be the best medications for treating their depression.
Combining Two SSRIs
Some people who take two selective seratonin reuptake inhibitors--SSRIs--or who take an SSRI while they are taking another prescription drug or over-the-counter medication, might have a reaction called
"serotonin syndrome." This syndrome can occur when two drugs that raise serotonin in the brain are taken simultaneously. Serotonin syndrome is rare but can be very serious. Common symptoms include confusion, hallucinations, loss of coordination, fever, rapid heart rate, and vomiting, according to the Agency for Healthcare Research and Quality. The medications that are risky to take with SSRIs include migraine headache medicines called triptans, cough medicines that contain dextromethorphan, pain killers like meperidine, L-tryptophan and St. John's Wort. People considering taking an antidepressant, especially an SSRI, should discuss with their physician any antidepressants or other medications, supplements or herbal remedies they are currently taking..
References
- American Journal of Psychiatry: Evaluation of Outcomes With Citalopram for Depression Using Measurement-Based Care in STAR*D: Implications for Clinical Practice
- Neuropsychiatric Disease and Treatment: Olanzapine and Fluoxetine Combination Therapy for Treatment-resistant Depression, 2009:5
- National Center for Biotechnology Information: Citalopram and Bupropion-SR: Combining Versus Switching in Patients with Treatment-resistant Depression
- U.S. Department of Health & Human Services Agency for Healthcare Research and Quality: Antidepressant Medicines
