Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

Brief Reports   |    
Use of Augmentation Agents for Treating Depression: Analysis of a Psychiatric Electronic Medical Record Data Set
Kenneth R. Gersing, M.D.; John J. Sheehan, Ph.D.; Bruce Burchett, Ph.D.; Ling Zhu, Ph.D.; John A. Bates, Ph.D.; Ross A. Baker, Ph.D.; Iftekhar D. Kalsekar, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300288
View Author and Article Information

Dr. Gersing and Dr. Burchett are with the Department of Psychiatry and Behavioral Science, Duke University Medical Center, Durham, North Carolina (e-mail: kenneth.gersing@duke.edu). When this work was done, Dr. Sheehan, Dr. Zhu, and Dr. Kalsekar were with Bristol-Myers Squibb, Plainsboro, New Jersey, where Dr. Bates is affiliated. Dr. Sheehan and Dr. Kalsekar are now with AstraZeneca, Fort Washington, Pennsylvania. Dr. Baker is with Otsuka Pharmaceutical Development and Commercialization, Inc., Princeton, New Jersey. The findings were presented at the annual meeting of the Academy of Managed Care Pharmacy, October 3–5, 2012, Cincinnati, Ohio.

Copyright © 2014 by the American Psychiatric Association


Objective  This study evaluated the relationship between patient characteristics and augmentation strategies for the treatment of major depressive disorder.

Methods  This retrospective, cross-sectional study used data from a psychiatric electronic medical record database for patients with depression without psychosis or psychotic features who initiated augmentation therapy between January 2001 and June 2011. Medical records were evaluated to identify factors predicting use of specific augmentation agents, and a multivariate logistic regression model was used to assess clinical and demographic predictors of augmentation strategy.

Results  Of 3,209 patients initiating augmentation therapy for depression, 75% received augmentation with an antidepressant combination and 11% received augmentation with second-generation antipsychotics. Baseline clinical severity (Clinical Global Impressions–Severity score) most strongly and consistently predicted augmentation with second-generation antipsychotics.

Conclusions  Treatment of patients in specialty settings with depression was often augmented with an antidepressant combination, whereas those with severe depression had an increased likelihood of augmentation with second-generation antipsychotics.

Abstract Teaser
Figures in this Article

Your Session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Anchor for Jump
Table 1Analysis of predictors of augmentation with second-generation antipsychotics compared with other types of augmentation agents
Table Footer Note

a CGI-S, Clinical Global Impressions–Severity



Greden  JF:  The burden of recurrent depression: causes, consequences, and future prospects.  Journal of Clinical Psychiatry 62(suppl 22):5–9, 2001
Keller  MB:  Past, present, and future directions for defining optimal treatment outcome in depression: remission and beyond.  JAMA 289:3152–3160, 2003
[CrossRef] | [PubMed]
Fava  M:  Diagnosis and definition of treatment-resistant depression.  Biological Psychiatry 53:649–659, 2003
[CrossRef] | [PubMed]
Dupuy  JM;  Ostacher  MJ;  Huffman  J  et al:  A critical review of pharmacotherapy for major depressive disorder.  International Journal of Neuropsychopharmacology 14:1417–1431, 2011
[CrossRef] | [PubMed]
 American Psychiatric Association Practice Guideline for the Treatment of Patients With Major Depressive Disorder.  American Journal of Psychiatry 167(suppl):1–152, 2010
[CrossRef] | [PubMed]
Nelson  JC;  Papakostas  GI:  Atypical antipsychotic augmentation in major depressive disorder: a meta-analysis of placebo-controlled randomized trials.  American Journal of Psychiatry 166:980–991, 2009
[CrossRef] | [PubMed]
Berman  RM;  Fava  M;  Thase  ME  et al:  Aripiprazole augmentation in major depressive disorder: a double-blind, placebo-controlled study in patients with inadequate response to antidepressants.  CNS Spectrums 14:197–206, 2009
Berman  RM;  Marcus  RN;  Swanink  R  et al:  The efficacy and safety of aripiprazole as adjunctive therapy in major depressive disorder: a multicenter, randomized, double-blind, placebo-controlled study.  Journal of Clinical Psychiatry 68:843–853, 2007
[CrossRef] | [PubMed]
Marcus  RN;  McQuade  RD;  Carson  WH  et al:  The efficacy and safety of aripiprazole as adjunctive therapy in major depressive disorder: a second multicenter, randomized, double-blind, placebo-controlled study.  Journal of Clinical Psychopharmacology 28:156–165, 2008
[CrossRef] | [PubMed]
Valenstein  M;  McCarthy  JF;  Austin  KL  et al:  What happened to lithium? Antidepressant augmentation in clinical settings.  American Journal of Psychiatry 163:1219–1225, 2006
[CrossRef] | [PubMed]
Noyes  K;  Liu  H;  Lyness  JM  et al:  Medicare beneficiaries with depression: comparing diagnoses in claims data with the results of screening.  Psychiatric Services 62:1159–1166, 2011
[CrossRef] | [PubMed]
Martinotti  G;  Di Nicola  M;  Di Giannantonio  M  et al:  Aripiprazole in the treatment of patients with alcohol dependence: a double-blind, comparison trial vs naltrexone.  Journal of Psychopharmacology 23:123–129, 2009
[CrossRef] | [PubMed]
Milea  D;  Guelfucci  F;  Bent-Ennakhil  N  et al:  Antidepressant monotherapy: a claims database analysis of treatment changes and treatment duration.  Clinical Therapeutics 32:2057–2072, 2010
[CrossRef] | [PubMed]
Chang  TE;  Jing  Y;  Yeung  AS  et al:  Effect of communicating depression severity on physician prescribing patterns: findings from the Clinical Outcomes in MEasurement-based Treatment (COMET) trial.  General Hospital Psychiatry 34:105–112, 2012
[CrossRef] | [PubMed]
References Container

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe

Related Content
Manual of Clinical Psychopharmacology, 7th Edition > Chapter 2.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 61.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 61.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 18.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 18.  >
Topic Collections
Psychiatric News
APA Guidelines
PubMed Articles