Section - Video Lectures

10. Antidepressant Augmentation After the First Failed Trial in Major Depressive Disorder (Node 4B – Part 2)

Published on November 2, 2019 Expired on March 31, 2022

David Osser, M.D.

Associate Professor of Psychiatry - Harvard Medical School

Key Points

Augmentation choices are:

Omega-3 fatty acids, l-methylfolate, n-acetylcystiene, or light therapy.
Atypicals—quetiapine, risperidone, or aripiprazole.
Bupropion or mirtazapine.
Lithium or thyroid (T3 or thyroxine).

To unlock this video you need to become a Bronze, Silver, Gold, Bronze extended, Silver extended or Gold extended Member.

Check Our CME Program

Downloads for Offline Access

Download Audio File (MP3)
Download MP4
Download Presentation File (PPTX)

Slides and Transcript

Slide 1 of 8

This is video 10 of the Psychopharmacology Algorithm for the Treatment of Major Depression from the Harvard South Shore Psychopharmacology Algorithm Project Group. We are working our way through the options for treating major depression in outpatients who are relatively uncomplicated. In this video, we discuss the augmentation choices to offer the patient should the patient prefer an augmentation to hold on to the antidepressant you gave them before and add to it.

Antidepressant Augmentation After the First Failed Trial in Major Depressive Disorder (Node 4B – Part 2) Slide 1 of 8

Slide 2 of 8

And here are the four augmentation choices. The first is to augment with a nutrient or one of these over-the-counter treatments that has some evidence of efficacy as an augmenter and would be expected to have little or no side effects. And the three that we recommend in this category are omega-3 fatty acid treatment. Typically, fish oil is used. Another is L-methylfolate which is actually available as a prescription product but it is basically a kind of vitamin. It’s a derivative of folate which is easily available over the counter. And we throw in to this augmentation group light therapy.

References:

Gertsik, L., Poland, R. E., Bresee, C., & Rapaport, M. H. (2012). Omega-3 fatty acid augmentation of citalopram treatment for patients with major depressive disorder. Journal of clinical psychopharmacology, 32(1), 61.
Papakostas, G. I., Cassiello, C. F., & Iovieno, N. (2012). Folates and S-adenosylmethionine for major depressive disorder. The Canadian Journal of Psychiatry, 57(7), 406-413.
Berk, M., Dean, O. M., Cotton, S. M., Jeavons, S., Tanious, M., Kohlmann, K., … & Schapkaitz, I. (2014). The efficacy of adjunctive N-acetylcysteine in major depressive disorder: a double-blind, randomized, placebo-controlled trial. The Journal of clinical psychiatry, 75(6), 628-636.
Perera, S., Eisen, R., Bhatt, M., Bhatnagar, N., de Souza, R., Thabane, L., & Samaan, Z. (2016). Light therapy for non-seasonal depression: systematic review and meta-analysis. BJPsych open, 2(2), 116-126.

Antidepressant Augmentation After the First Failed Trial in Major Depressive Disorder (Node 4B – Part 2) Slide 2 of 8

Unlock this Video Lecture and earn 1.50 CMEs
Become a Bronze, Silver, Gold, Bronze extended, Silver extended or Gold extended Member.

Get Instant Access

Already have an account? Sign in

Next Section

11. Treatment-Resistant Depression Without Comorbidity: Treatment Options (Node 5)