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Mental health
Study supports augmentation with a non-antidepressant agent over combining or switching antidepressants in unipolar depression
  1. Stephan Köhler,
  2. Philipp Sterzer
  1. Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
  1. Correspondence to PD Dr. Stephan Köhler, Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin 10117, Germany; stephan.koehler{at}

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Commentary on: Mohamed S, Johnson GR, Chen P, et al. Effect of antidepressant switching vs augmentation on remission among patients with major depressive disorder unresponsive to antidepressant treatment: the VAST-D randomized clinical trial. JAMA 2017;318,132–45.


Fifty per cent of patients with a major depressive disorder (MDD) do not yield a satisfactory response to an antidepressant. Even after several treatment approaches, the rate of patients with refractory depression is still 30%.1 In case of non-response to therapy, adding a drug from a different pharmaceutical class to the antidepressant treatment has been shown to have an augmentative effect.2 Most evidence is available for augmentation with lithium3 and atypical antipsychotics.4 Evidence for switching to another antidepressant is far weaker.5 The efficacy of combining two antidepressants is limited to some specific combinations.6 The Veterans Affairs Augmentation and Switching Treatments for Improving Depression Outcomes (VAST-D) randomised controlled trial (RCT) …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.