What we’ve said about Augmentation

“But then if something's not working and it's an adequate dose, you either switch or you augment. Now, I like to augment, but really, the research does not show superiority of one approach or another. You can switch or you can augment”

“We have someone at a adequately dosed SSRI or SNRI, and we want to add something. As we mentioned, there is Wellbutrin and Mirtazapine, but you could also consider Buspar. And unfortunately or fortunately, you can also venture into the territory of the second generation antipsychotics, which is very popular in the U.S., but high risk”

“To me, they're early meds to the Bupro and the mirtazapine. In my mind, I consider them to be augmenting agents”

“So for me, clomipramine and Luvox are still within the primary treatment arm. And then for augmentation, I like to go from least harmful to most harmful”

“Typically, I use an SSRI. That doesn't work. I'll switch to another SSRI. We're talking augmenting agents, considering buspirone or gabapentin. If their patient's still unresponsive to, you know, a bunch of these things, you can start kind of going off patient characteristics. If there's a lot of sleep issues, I'll consider mirtazapine”

“great augmenting choice for people with energy issues and anorgasmia from the SRIs. You can actually give bupropion for anorgasmia in the absence of a mood disorder. It seems to help”

“Works for augmentation. Just don't under dose it. Start at 15. But be ready to go down if it's a patient who's more sensitive to it. And don't be afraid to take it to the max buspirone”

“I think mechanistically and experientially, totally worth an add-on for almost any kind of neurotic illness. It's very low risk and within the FDA limits and relatively well-tolerated, not a lot of side effects”

“I do think they work, and I don't think it's just that it's people misdiagnosed with bipolar disorder or something like that. I suspect it's just that the second-generation antipsychotics have a lot of different receptor effects, unique ones, that are not present if you have a selective serotonin reuptake inhibitor”

“It's got lower risk of tardive dyskinesia than other ones, and it's pretty dang well tolerated. It's so well tolerated, it's hard to get patients off of it sometimes once they're stabilized”

“Lamotrigine is a reasonable option. N-acetylcysteine is particularly good, especially with skin picking. That's a supplement. It's not a prescribed medication. I've been reading more and more about Ondansetron as potentially one of the most effective add-ons for OCD”

“Do not dose-abilify above 5 mg if what you are trying to do is trying to treat major depressive disorder without psychotic features. Do not do it. Just don't do it. It's not worth it”

“at the bottom of that evidence ladder sits bupropion and mirtazapine and basically buspirone, another antidepressant augmenting. So taking two antidepressants rarely ever works better than taking one, which is what we most often do”

“people reach for antipsychotic first because they're so used to it now right we're all primed to using the antipsychotic as augmentation depression anxiety even”

“If you add low dose Abilify to another antipsychotic, you're actually not adding more antipsychotic. You're taking antipsychotic away because the Abilify will bind more tightly most of the time and at a low dose will not be acting as an antipsychotic”