Antidepressant dosing and brand name:
Algorithm for depression treatment:
Pharmacologic treatment options for patients with treatment-resistant depression include switching to another antidepressant or augmenting with a second agent. This patient has failed to respond to an adequate trial (>6 weeks) of high-dose fluoxetine. Patients with little to no improvement (nonresponders) or unacceptable tolerability generally benefit from switching to another antidepressant rather than augmentation. Discontinuing fluoxetine and starting venlafaxine, a serotonin-norepinephrine reuptake inhibitor, would be the most appropriate next step.
Partial responders, in contrast, can consider augmentation as a first-line option as switching carries a risk of losing the partial therapeutic benefit from the original drug. Augmentation strategies include adding a second-generation antipsychotic, an antidepressant with a different mechanism of action, or occasionally lithium or triiodothyronine.
The second-generation antipsychotic aripiprazole is an effective augmentation strategy for treatment-resistant major depression. However, it is not used as monotherapy.