How should a failure to respond to initial antidepressant therapy be managed?

Choosing to add a second antidepressant can be an effective strategy in managing a patient's lack of response to initial therapy. This approach, known as augmentation, allows for a broader spectrum of action by combining the mechanisms of different medications. Since various antidepressants affect different neurotransmitter systems, adding a medication with a complementary mechanism can enhance therapeutic effects and address symptoms more comprehensively.

This method is particularly relevant when a patient has not shown improvement with a single agent due to varying individual responses to treatments. For example, combining an SSRI with a different class of antidepressants, such as an atypical antipsychotic or a mood stabilizer, can be beneficial for augmenting treatment.

This approach can also be helpful when the initial dose is subtherapeutic or if the side effect profile of the current medication limits dose escalation. However, it is essential to monitor the patient closely for potential side effects of the combined medications and to assess overall effectiveness over time.