Depression is a mental health disorder that is typically characterized by having a persistently depressed mood, a loss of interest in activities that were once enjoyable, and having an overwhelming feeling of sadness at all times (1). If you have been diagnosed with major depressive disorder, then chances are high that your doctor has put you on at least one major antidepressant. With the advances in the medicine, there have been many new drugs and medical therapies that are being used for treatment of depression. Combination drug therapy is one such innovative treatment plan that many psychiatrists and doctors are increasingly using in recent years. Using combination therapies for depression treatment has become a popular solution for medical experts today and we take a look at how combination therapies work, what it entails and whether or not it helps in the treatment of depression.
Combination Therapies For Depression
Some of the difference types of therapies and medications used in combination drug therapy for depression are discussed below.
Antidepressant Medications for Treating Depression
Until the last couple of years, doctors used to prescribe only one major antidepressant medication from a single class of drugs, at one point in time. This process is known as monotherapy. If that specific prescribed drug failed to provide any relief, then the doctors would opt for trying another medication, either from within that class of drugs itself or they may switch over to another class of antidepressants also.
Research has now shown that taking antidepressants from different classes of antidepressants is the best way for treating major depressive disorder (MDD) (2). A study published in The American Journal of Psychiatry in March 2010 found that the use of a combination antidepressant approach at the very first sign of MDD doubles the likelihood of remission.
Using Atypical Antidepressant Medications for Depression
There may be certain medications that, when used in conjunction with other medications, work wonders in treating difficult-to-treat to severe levels of depression. For example, when used on its own, the medication bupropion is known to be quite effective at treating MDD. However, when used in conjunction with other medications, it may yield even better results, especially in treating severe levels of depression. Bupropion is, in fact, one of the most commonly used antidepressants in combination therapy medications. Bupropion is also used commonly with serotonin-norepinephrine reuptake inhibitors (SNRIs) and selective serotonin reuptake inhibitors (SSRIs).
Bupropion is also one such medication that generally well tolerated by most people who have earlier experienced the severe side effects of other antidepressant medications. Bupropion is also known to provide relief in the sexual side effects that are commonly associated with SNRIs and SSRIs, such as a decreased libido and anorgasmia (3).
Mirtazapine is also another good option to be used by people who are experiencing a loss of appetite and also suffering from insomnia due to MDD. However, the most common side effect of mirtazapine is sedation and weight gain (4). Mirtazapine also has not been studied as comprehensively for use as a combination medication as bupropion has been.
Atypical Antipsychotics for Treating Depression
Research studies have also shown that patients suffering from MDD may benefit in some of the residual symptoms by taking SSRIs combined with atypical antipsychotics. Medications such as aripiprazole can be used in combination with SSRIs, though there are certain side effects associated with these medications, including muscle tremors, metabolic disturbances and weight gain. This is why atypical antipsychotics have to be considered carefully before being used in combination therapies since they may very well prolong or worsen some of the symptoms of depression.
Many doctors also use L-Triiodothyronine (T3), which is a thyroid hormone, in combination therapy with monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs). Studies have shown that T3 is better at boosting the body’s response to depression treatment, as compared to increasing the chances of entering remission (5).
Using Stimulants for Depression
Methylphenidate (Ritalin) and D-amphetamine (Dexedrine) are the stimulants that are being used in the treatment of depression. These stimulants can also be used as monotherapy; however, they are also being used as part of combination therapy for depression along with antidepressant medications. Stimulants have been proven to be most beneficial when doctors are looking for a quick response from the patients. Patients who also have comorbid conditions such as a chronic medical illness or a stroke, or those who are debilitated, make for good candidates for this combination therapy with stimulants.
Using Combination Therapy as the First Line of Treatment in Major Depressive Disorder (MDD)
Monotherapy treatments have been found to have a relatively low rate of success, which is why many doctors and mental health experts believe that using combination therapies as the first approach to treating MDD is the best solution available (6). Nevertheless, most doctors still begin the treatment with the use of a single antidepressant medication itself.
If you have been put on combination therapy for treating depression, then you need to give it some time to work. Usually, two to four weeks is considered to be the trial period for any new medication for depression. If during this period, you do not show any adequate response, then your doctor may change a medication or add some additional medication to change the combination for better treatment of depression. It may take some trials before you hit upon a treatment plan for depression that succeeds.
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