Faculty Opinions recommendation of Pharmacotherapy augmentation strategies in treatment-resistant anxiety disorders.

ABSTRACTManagement strategies for treatment-resistant depression and anxiety disorders have evolved over the last decade. Our understanding of the factors that impair recovery from an episode of major depression has increased, leading to the development of more precise diagnostic methodology that highlight the presence of comorbid conditions. New medications, creative uses of existing medications, increased empirical data about augmentation strategies, and the development of innovative nonpharmacologic interventions are responsible for a marked expansion in treatment options. Traditionally, augmentations with lithium, thyroid hormones, or electroconvulsive therapy have demonstrated effectiveness in some patients with treatment-resistant mood disorders. Among the promising treatments in both depression and anxiety is augmentation using low-dose antipsychotics medications, combining antidepressants of different classes, and the addition of psychotherapy. Nonpharmacologic interventions that may have potential include transcranial magnetic stimulation, deep-brain stimulation, and vagus-nerve stimulation. This article provides a brief review of the available data summarizing existing and new treatment strategies in depression and anxiety disorders.

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Pharmacotherapy augmentation strategies in treatment-resistant anxiety disorders

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd005473.pub2 ◽

2006 ◽

Cited By ~ 20

Author(s):

Jonathan C Ipser ◽

Paul Carey ◽

Yumna Dhansay ◽

Nuraan Fakier ◽

Soraya Seedat ◽

...

Keyword(s):

Anxiety Disorders ◽

Treatment Resistant ◽

Augmentation Strategies

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Augmentation Strategies for Clozapine-Resistant Patients with Schizophrenia

Current Pharmaceutical Design ◽

10.2174/1381612826666200110102254 ◽

2020 ◽

Vol 26 (2) ◽

pp. 218-227

Author(s):

Yi-Hang Chiu ◽

Chia-Yueh Hsu ◽

Mong-Liang Lu ◽

Chun-Hsin Chen

Keyword(s):

Sample Size ◽

Repetitive Transcranial Magnetic Stimulation ◽

Mood Stabilizers ◽

Treatment Resistant ◽

Double Blind ◽

Beneficial Effects ◽

Augmentation Strategies ◽

Pubmed Database ◽

Augmentation Strategy ◽

Larger Sample

Background: Clozapine has been used in treatment-resistant patients with schizophrenia. However, only 40% of patients with treatment-resistant schizophrenia have response to clozapine. Many augmentation strategies have been proposed to treat those clozapine-resistant patients, but the results are inconclusive. In this review, we intended to review papers dealing with the augmentation strategies in the treatment of clozapineresistant patients with schizophrenia. Method: We reviewed randomized, double-blind, placebo- or sham-controlled trials (RCT) for clozapine-resistant patients with schizophrenia in Embase, PsycINFO, Cochrane, and PubMed database from January 1990 to June 2019. Results: Antipsychotics, antidepressants, mood stabilizers, brain stimulation, such as electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation, and other strategies, were used as an augmentation in clozapine-resistant patients with schizophrenia. Except for better evidence in memantine with 2 RCTs and cognitive behavior therapy in 2 studies to support its effectiveness, we found that all the other effective augmentations, including sulpiride, ziprasidone, duloxetine, mirtazapine, ECT, sodium benzoate, ginkgo biloba, and minocycline, had only one RCT with limited sample size. Conclusion: In this review, no definite effective augmentation strategy was found for clozapine-resistant patients. Some potential strategies with beneficial effects on psychopathology need further studies with a larger sample size to support their efficacy.

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