Section - Quick Takes

04. Combining Antidepressants vs Antidepressant Monotherapy for Treatment of Patients With Acute Depression

Published on June 1, 2022 Expired on June 1, 2025

James Phelps, M.D.

Research Editor - Psychopharmacology Institute

Key Points

According to a series of meta-analyses, for a patient whose depression has not responded to an antidepressant, continuing the same dose of the same antidepressant works as well as switching or increasing the dose or augmenting with bupropion. Augmenting with an alpha-2 antagonist (mirtazapine or mianserin) worked slightly better (effect size 0.24).

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One of the most common issues you face, I suspect, is what to do when you’ve prescribed an antidepressant and the patient’s depression has not improved. Is it better to switch, augment, turn up the dose? Or perhaps just wait longer at the same dose?

Hi! Jim Phelps here for the Psychopharmacology Institute. In a series of 3 meta-analyses, a German research team led by Dr. Christopher Baethge attempted to synthesize available data regarding these questions. Caution, these are not just single studies—they’re meta-analyses, and the results are so contrary to common practice that you may not choose to change your ways immediately. But they certainly do make you think.

First, let’s look at the switching strategy. You’ll remember the STAR*D study, which studied switching vs augmenting for patients who had not responded to a first antidepressant monotherapy. The conclusion there was that switching and augmenting had roughly equivalent outcomes.

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05. Akathisia and Atypical Antipsychotics: Relation to Suicidality, Agitation, and Depression in a Clinical Trial

Learning Objectives:

After completing this activity, the learner will be able to:

Determine which antidepressant among those studied is associated with better outcomes in the treatment of PTSD.
Compare 11 medications (either monotherapy or combination) for the treatment of severe agitation in the emergency department using network meta-analyses.
Evaluate the efficacy of treatments for ADHD in young people who also manifest irritability.
Reconsider routine practices for antidepressant nonresponse in light of 3 recent meta-analyses.
Examine the prevalence of akathisia among inpatients with schizophrenia who are treated with second-generation antipsychotics.

Original Release Date: June 1, 2022

Review and Re-release Date: March 1, 2024

Expiration Date: June 1, 2025

Expert: James Phelps, M.D.

Medical Editor: Melissa Mariano, M.D.

Relevant Financial Disclosures:

None of the faculty, planners, and reviewers for this educational activity have relevant financial relationships to disclose during the last 24 months with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Contact Information: For questions regarding the content or access to this activity, contact us at support@psychopharmacologyinstitute.com

Instructions for Participation and Credit:

Participants must complete the activity online during the valid credit period that is noted above.

Follow these steps to earn CME credit:

View the required educational content provided on this course page.
Complete the Post Activity Evaluation for providing the necessary feedback for continuing accreditation purposes and for the development of future activities. NOTE: Completing the Post Activity Evaluation after the quiz is required to receive the earned credit.
Download your certificate.

Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medical Academy LLC and the Psychopharmacology Institute. Medical Academy is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement

Medical Academy designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.