Mental health

June 2011

Clinical

Combination antidepressants

Use by GPs and psychiatrists

Volume 40, No.6, June 2011 Pages 397-400

David Horgan

Seetal Dodd

Background

Current treatment of depression fails to achieve remission in 50% of patients. Combinations of two antidepressants are used by some Australian psychiatrists.

Objective/s

This article investigates the pros and cons of combination antidepressant therapy and provides suggestions for when to consider their use, which combinations to choose, and how to introduce combination antidepressant therapies.

Discussion

Combining two antidepressants is a controversial strategy, with supporters and critics arguing its efficacy and safety from opposing perspectives. The use of combination antidepressant therapies may facilitate remission from depression. However, there is limited evidence supporting these treatments, and safety concerns are often cited. There is some support for combination therapies in selected cases from international bodies. After considering risks and benefits on a case-by-case basis, careful use of selected combination antidepressant therapy may be one of a range of effective treatments for some individuals suffering from depression.

For 50% of sufferers, depression is a lifelong illness. A 23 year follow up of first episode depression showed the illness to be unremitting in 15% of patients, and recurrent in 35%.1 Analogous to cancer, failure to achieve total eradication of depressive illness (remission) by vigorous treatment worsens the prognosis regarding recovery and relapse.

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Correspondence afp@racgp.org.au

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