Do I Need an Add-on Drug to Enhance my Antidepressant?

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So you go to your doctor or psychiatrist and you finally agree to take an antidepressant. Yet to your dismay you find that your depression symptoms are not fully going away. What now? In addition to talk therapy or other non-prescription remedies to treat depression your doctor may also recommend that you take an add-on or augmentation medication or supplement along with your antidepressant to increase its effectiveness. In a previous post I discussed how many of us are taking a "medication cocktail" which means we are using multiple medications for treating the same disorder. There are risks to taking any medication and this risk can be compounded when we take two or more medications to treat the same disorder or illness. Yet in some cases you and your doctor may decide that the possible benefits outweigh the risks so that you can effectively treat your depression.

In this on-going series we are going to talk about add-on or augmentation medications and supplements designed to enhance the effectiveness of your antidepressant. In this initial post we will discuss how to make that decision as to whether or not you need a second medication to treat your depression.

Safety First: Always research any prescription medications or supplements before you add them to your medication treatment plan. Discuss any potential drug interactions and side effects with your doctor or pharmacist.

Why would you need an add-on medication or supplement in addition to your antidepressant?

The Stanford Mood and Anxiety Disorders Laboratory reports that, in general, 2/3 of people who suffer from depression will respond to any given antidepressant. So that seems to leave a third who may be considered treatment resistant. The National Institute of Mental Health funded research they call the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study. This large scale study was created to judge the efficacy of various treatments for people who suffer from major depression who did not respond adequately to an initial treatment with an antidepressant.

Here are a couple of interesting things they found in doing this study:

  • For those people who don't respond when one SSRI fails, approximately 1 in 4 people who switch to another antidepressant will get better regardless if the second medication is also an SSRI or if it is from another class of antidepressants such as an SNRI.

  • If a patient adds a new drug to their existing SSRI, 1 in 3 people will get better. They report that it makes little difference if the add-on drug is an antidepressant from a different class of drugs or if it is a medication designed to enhance or augment the SSRI.

This seems to offer hope for those folk who do not find relief from their initial attempt at taking an antidepressant.

Here are some general guidelines found in the literature as to steps to take when your first antidepressant doesn't work:

1. Before you decide to take a second medication see if non-prescription treatments are an effective addition to your antidepressant.

Many patients respond favorably to a combination of medication and talk therapy. A 2004 Consumer Reports Survey of its readers found that patient respondents who reported that their therapy was "mostly talk" and lasted 13 sessions had better outcomes than those whose therapy was "mostly medication." We have written extensively about other forms of non-medication including therapeutic massage, therapeutic laughter therapy, exercise, and changing your diet.

2. Give your antidepressant at least two months to fully take effect.

This is the recommendation given on the Stanford Mood and Anxiety Disorders Laboratory website. Antidepressants usually take a good 6-8 weeks to reach their full therapeutic effect. But sometimes they take a little more time. After taking an antidepressant for a full two months you can honestly say that you gave it a good chance. The main reason people usually quit before this time is up is due to adverse severe side effects. But in two months time many side effects will diminish. Another reason some will stop an antidepressant early on is a worsening of depression and a dramatic increase in suicidal thoughts.

If you are having any difficulties with your medication you need to speak with your doctor. Never quit a medication cold turkey as there is the potential for withdrawal symptoms and some can be severe.

3. Your doctor may opt to increase the dosage of your antidepressant.

The dosage of your medication is an extremely important key to whether or not your antidepressant will work for you. This is not an exact science and you may go through a period of months before the dosage of your antidepressant is at the peak therapeutic level for you. So many things can affect how your medication works. Your schedule of when you take your medication, foods you eat, and interactions with other supplements and medications can greatly affect the effectiveness of your antidepressant.

4. Your doctor may suggest switching you to a different antidepressant.

There are certainly many antidepressants to choose from nowadays. To read up on your choices please see our Antidepressant Drug Information guide.

5**. Your doctor may suggest an add-on or augmentation medication or supplement to enhance the effectiveness of the antidepressant you are already taking.**

It may be the case where your antidepressant is helping some but is not quite as effective as you would like. Instead of making a switch to a totally new medication, your doctor may opt to simply add on a second drug or supplement to augment or enhance your current antidepressant. There is a long list of add-on drugs which are prescribed for this purpose. In future posts we will explore some of these augmentation medications and how they work.