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Augmenting SSRIs in Treatment-Resistant Depression: What Is Best?
Medscape Medical News
Dr. Peter Yellowlees
February 25, 2014

Among the many strategies used to assist patients with treatment-resistant depression is augmentation of selective serotonin reuptake inhibitor (SSRI) antidepressant therapy with either lithium or an atypical antipsychotic drug.

Now a team of investigators 1 from the British Medical Journal Technology Assessment Group in London, United Kingdom, have estimated the clinical- and cost-effectiveness of these 2 strategies.

Using Cochrane review methodology, they found 12 relevant randomized controlled trials, and despite some methodological concerns they concluded that augmentation of SSRIs with lithium or an atypical antipsychotic drug is likely to be beneficial in patients with treatment-resistant depression, and that there was no statistically significant difference between the 2 augmentation strategies.

Cost-effectiveness analyses suggested that augmentation with lithium is less expensive and is consequently more effective overall than augmentation with an atypical antipsychotic agent.

Although much more research is needed into the strategies required to treat patients with treatment-resistant depression, this review provides more evidence for the clinical value of augmentation with either lithium or atypical antipsychotics, and reminds us of the importance of using cheaper, well-tried and tested medications such as lithium.

1) Edwards SJ, Hamilton V, Nherera L, Trevor N. Lithium or an atypical antipsychotic drug in the management of treatment-resident depression: a systematic review and economic evaluation. Health Technol Assess. 2013;17:1-190.

Abstract :acrobat: attached


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