Table 7.
Dosing strategies for augmentation agents for treatment-resistant depression
| Augmentation agents | Recommended dosing strategies | Side effects |
|---|---|---|
| Lithium | Initially 150 mg twice daily to be increased in accordance with blood level (0.4–0.8 mEq/L) and clinical response | Tremors, weight gain, polydipsia, polyurea |
| Triiodothyronine | 25–50 μg/day for 3 weeks | Irritability, sweating, palpitation, and anxiety |
| Olanzapine | 2.5–5 mg/day | Sedation and weight gain |
| Ziprasidone | 20–40 mg/day | Sedation and weight gain |
| Risperidone | 0.5–1 mg/day | Sedation and weight gain |
| Methylphenidate | 5–30 mg/day | Insomnia, irritability, GI symptoms, abuse and blood pressure/heart rate variability |
| Dextroamphetamine | 10–20 mg/day | Insomnia, irritability, GI symptoms, abuse and blood pressure/heart rate variability |
| Modafinil | 200 mg/day | Headache, dizziness, nausea and dry mouth |
| Primapexole | 0.25–2.5 mg/day | Nausea and agitation |
| Inositol | 500–1000 mg/day | Not available |
| Estrogen | 0.1–0.2 mg patch | Risk for breast and uterine cancer, weight gain, and edema |
| Omega-3 fatty acids | 6 g EPA and 2 g DHA | Unpleasant fishy burp |
| Lamotrigine | 12.5–25 mg/day initially; increase by 12.5–25 mg/week up to 100–220 mg/day | Nausea, headache, blurry vision, rash and sleepiness |
Notes: Pindolol, T4, and herbal supplements are not recommended.
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
Abbreviations: DHA, docosahexaenoic acid; EPA, eicosapentaenoic acid; GI, gastrointestinal.