Is augmentation treatment effective for patients with treatment-resistant depression?

The available evidence that treatment-resistant depression—depression unresponsive to 2 different treatments of adequate dose and length—responds well to augmentation treatment (ie, adding psychotherapy, lithium, or aripiprazole [Abilify] to current treatment) is weak. The available evidence shows no benefit with lithium and small benefit with psychotherapy or aripiprazole. (LOE = 1a-)

Strawbridge R, Carter B, Marwood L, et al. Augmentation therapies for treatment-resistant depression: systematic review and meta-analysis. Br J Psychiatry 2019;214(1):42-51.  [PMID:30457075]

Meta-analysis (randomized controlled trials)

Government

Various (meta-analysis)

The authors searched 2 databases (but not the Cochrane Library) for randomized studies of augmentation treatment for patients who did not respond to at least 2 courses of treatment for major depressive disorder.Two authors selected studies for inclusion and independently extracted the data. Most of the 28 studies of 5461 patients had low to moderate risk of bias (ie, were of medium to high quality) and included both drug treatment and psychological therapies. Instead of comparing directly across treatments (that is, the benefit in one group vs the other), the authors compared the before-after change in results within each group. In 3 low-quality studies, psychological treatment showed a moderate benefit. In 4 studies of aripiprazole, there was a small likelihood of benefit after short-term treatment (effect size = 1.33; 95% CI 1.23 - 1.44) as compared with placebo. Lithium produced an effect size similar to placebo.