Table 6.
Mechanism of action of agents used as augmentation for treatment-resistant depression
Augmentation agent | Mechanism of action |
---|---|
Lithium | Potentiate serotonergic neurotransmission, modulates phosphatidyl-inositol pathway |
Triiodothyronine | Potentiate norepinephrine neurotransmission, corrects subclinical hypothyroidism that causes depression-like symptoms |
Atypical antipsychotics | Improve frontal serotonin, norepinephrine, and dopamine functions, and other neurotransmitters such as glutamate |
Psychostimulants | Improve norepinephrine and dopamine neurotransmission |
Inositol | Precursor of diacylglycerol and inositol triphosphate |
Estrogen | Affects gamma aminobutyric acid, serotonergic, noradrenergic and cholinergic neurotransmission |
Omega-3 fatty acids | Normalize communication in nerve cells; lower tumor necrosis factor-α; lower interleukin-B; lower prostaglandins E 2, 3, 4; and increase brain-derived neurotrophic factor |
Dopamine agonists | Increase dopamine tone |
Herbal supplements | May impact monoaminergic neurotransmission |
Lamotrigine | Blocks 5-hydroxytriptamine 3 receptors, potentiates dopamine |
Tetraiodothyronine | Potentiates norepinephrine neurotransmission |
Pindolol | Increases serotonergic tone |
Copyright © 2005, MBL Communications. Adapted with permission from Gotto J, Rapaport MH. Treatment options in treatment-resistant depression. Prim Psychiatry. 2005;12:42–50.46