A new clinical survey has shown that antidepressant therapy is commonly augmented with other psychotropic medications, despite a lack of evidence in the efficacy of these different approaches.
The study was done by US researchers who obtained data on 244,859 Veterans Administration patients who were diagnosed with depression (but no other psychiatric condition) and prescribed an antidepressant during 2002.
Over one in 5 patients, or 22%, received an augmenting agent, researcher Marcia Valenstein and co-authors reported in the American Journal of Psychiatry. Of these, 4% received more than one such treatment throughout the year.
The most popular augmentation techniques were a second antidepressant (11%) and a second-generation antipsychotic (7%), followed by an anticonvulsant (4%) and other agents (5%).
Surprisingly, the researchers found that only .5% of patients received lithium augmentation, despite this agent being generally regarded as having the strongest research support as well as a specific anti-suicide effect.
In demographic terms, Caucasians, younger patients, and those with prior hospitalization were more likely to receive augmentation. African Americans were more likely to receive an add-on antipsychotic while Caucasians were more likely to be given lithium.
Valenstein et al said that a wide variety of augmenting agents seem to be used in clinical practice, despite the limited research evidence supporting their efficacy. Furthermore, their data suggest that lithium augmentation “may be a vanishing practice,” though the possible reasons for this remain unclear.
The research team concluded that, “There is an urgent need for additional randomized controlled trials that examine the relative effectiveness of the various augmenting agents across the depressed patient population.”
© Copyright 2007 Insight Journal Online Magazine.
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