Rachael W Taylor1,2, Lindsey Marwood1, Emanuella Oprea1,3, Valeria DeAngel1,2, Sarah Mather4, Beatrice Valentini1,5, Roland Zahn1,2, Allan H Young1,3,2, Anthony J Cleare1,3,2. 1. The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, United Kingdom. 2. National Institute for Health Research Maudsley Biomedical Research Centre, South London & Maudsley NHS Foundation Trust, London, United Kingdom. 3. South London and Maudsley NHS Foundation Trust, London, United Kingdom. 4. Oxford Health NHS Foundation Trust, Oxford, United Kingdom. 5. Department of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.
Abstract
BACKGROUND: Pharmacological augmentation is a recommended strategy for patients with treatment-resistant depression. A range of guidelines provide advice on treatment selection, prescription, monitoring and discontinuation, but variation in the content and quality of guidelines may limit the provision of objective, evidence-based care. This is of importance given the side effect burden and poorer long-term outcomes associated with polypharmacy and treatment-resistant depression. This review provides a definitive overview of pharmacological augmentation recommendations by assessing the quality of guidelines for depression and comparing the recommendations made. METHODS: A systematic literature search identified current treatment guidelines for depression published in English. Guidelines were quality assessed using the Appraisal of Guidelines for Research and Evaluation II tool. Data relating to the prescription of pharmacological augmenters were extracted from those developed with sufficient rigor, and the included recommendations compared. RESULTS: Total of 1696 records were identified, 19 guidelines were assessed for quality, and 10 were included. Guidelines differed in their quality, the stage at which augmentation was recommended, the agents included, and the evidence base cited. Lithium and atypical antipsychotics were recommended by all 10, though the specific advice was not consistent. Of the 15 augmenters identified, no others were universally recommended. CONCLUSIONS: This review provides a comprehensive overview of current pharmacological augmentation recommendations for major depression and will support clinicians in selecting appropriate treatment guidance. Although some variation can be accounted for by date of guideline publication, and limited evidence from clinical trials, there is a clear need for greater consistency across guidelines to ensure patients receive consistent evidence-based care.
BACKGROUND: Pharmacological augmentation is a recommended strategy for patients with treatment-resistant depression. A range of guidelines provide advice on treatment selection, prescription, monitoring and discontinuation, but variation in the content and quality of guidelines may limit the provision of objective, evidence-based care. This is of importance given the side effect burden and poorer long-term outcomes associated with polypharmacy and treatment-resistant depression. This review provides a definitive overview of pharmacological augmentation recommendations by assessing the quality of guidelines for depression and comparing the recommendations made. METHODS: A systematic literature search identified current treatment guidelines for depression published in English. Guidelines were quality assessed using the Appraisal of Guidelines for Research and Evaluation II tool. Data relating to the prescription of pharmacological augmenters were extracted from those developed with sufficient rigor, and the included recommendations compared. RESULTS: Total of 1696 records were identified, 19 guidelines were assessed for quality, and 10 were included. Guidelines differed in their quality, the stage at which augmentation was recommended, the agents included, and the evidence base cited. Lithium and atypical antipsychotics were recommended by all 10, though the specific advice was not consistent. Of the 15 augmenters identified, no others were universally recommended. CONCLUSIONS: This review provides a comprehensive overview of current pharmacological augmentation recommendations for major depression and will support clinicians in selecting appropriate treatment guidance. Although some variation can be accounted for by date of guideline publication, and limited evidence from clinical trials, there is a clear need for greater consistency across guidelines to ensure patients receive consistent evidence-based care.
Authors: Manisha Madhoo; Richard S E Keefe; Robert M Roth; Angelo Sambunaris; James Wu; Madhukar H Trivedi; Colleen S Anderson; Robert Lasser Journal: Neuropsychopharmacology Date: 2013-12-06 Impact factor: 7.853
Authors: Lucas McKeown; Rachael W Taylor; Elana Day; Rupal Shah; Lindsey Marwood; Helena Tee; Jess Kerr-Gaffney; Emanuella Oprea; John R Geddes; R Hamish McAllister-Williams; Allan H Young; Anthony J Cleare Journal: J Psychopharmacol Date: 2022-04-27 Impact factor: 4.562
Authors: Elana Day; Rupal Shah; Rachael W Taylor; Lindsey Marwood; Kimberley Nortey; Jade Harvey; R Hamish McAllister-Williams; John R Geddes; Alvaro Barrera; Allan H Young; Anthony J Cleare; Rebecca Strawbridge Journal: BJPsych Open Date: 2021-05-14