Table 1.
Some antidepressant augmenting agents used in treatment resistant depression1
| Augmenting Agent | Proposed Mechanism | Comment |
|---|---|---|
| Pindolol | 5-HT1A receptor antagonist | May speed SSRI onset; ineffective in TRD in larger trials (Perez et al. 1979) |
| Buspirone | 5-HT1A partial agonist | Used in STAR*D; no consistent placebo-controlled data suggesting efficacy in TRD (Trivedi et al. 2006) |
| Lamotrigine | Glutamate antagonist | Effective in bipolar depression; uncertain efficacy in TRD (Barbee and Jamhour, 2002) |
| S-adenosylmethionine | Methyl donor | Effective in study of SSRI-resistant patients (Papakostas et al. 2010) |
| Folic acid | Methyl donor | Ineffective in a recent large trial (Bedson 2014) |
| L-methylfolate | Methyl donor | Possibly effective in a dose of 15mg daily (Papakostas et al. 2012) |
| Metyrapone | Blocks cortisol synthesis | Ineffective in a recent large trial (McAllister-Williams et al. 2016) |
| Modafinil | Stimulant | Moderately effective in meta-analysis (Goss et al. 2013) |
| Lisdexamfetamine | Stimulant | Ineffective in phase 3 trials (Papakostas & Ionescu, 2015) |
| Eicosapentaenoic acid (EPA) | Anti-inflammatory | Possibly effective in small randomised trials (Nemets et al. 2002) |
1
Adapted from Cowen and Anderson 2015