Augmentation agents for Depression
Approximately 70% of people will fail to respond to the first antidepressant
Switching to another antidepressant should be the next step, including a different SSRI or an antidepressant with a different mode of action
There is no strong evidence to support one type of augmentation or combination over another, patient choice and factors such as comorbidities and other medications should be the deciding factors
Cochrane review of Pharmacological interventions for treatment‐resistant depression in adults
Add 30 - 45mg/day to SSRI or venlafaxine
| Pack | Price |
|---|---|
| 28 tablet | £2.84 |
| 30 tablet |
| Pack | Price |
|---|---|
| 28 tablet | £1.22 |
| 30 tablet |
| Pack | Price |
|---|---|
| 28 tablet | £2.77 |
| 30 tablet |
| Pack | Price |
|---|---|
| 30 tablet | £1.24 |
| 6 tablet |
| Pack | Price |
|---|---|
| 30 tablet | £1.34 |
| Pack | Price |
|---|---|
| 30 tablet | £1.79 |
| Pack | Price |
|---|---|
| 30 tablet |
| Pack | Price |
|---|---|
| 30 tablet |
| Pack | Price |
|---|---|
| 1 ml |
Add to antidepressant
Aim for plasma level of 0.4-0.8 mmol/L initially, increasing to up to 1.0 mmol/L if suboptimal response
Lithium level must be measured weekly until stable, then 3 monthly for the first year and a minimum of six monthly thereafter
Calcium, thyroid and renal function must be monitored every 6 months.
Ensure patient has a Lithium information record card
Lithium treatment care pathway (to be completed before requesting GPs to prescribe
Lithium citrate tetrahydrate 509mg = 200mg lithium carbonate
This is a twice daily preparation
Add to antidepressant
Aim for plasma level of 0.4-0.8 mmol/L initially, increasing to up to 1.0 mmol/L if suboptimal response
Lithium level must be measured weekly until stable, then 3 monthly for the first year and a minimum of six monthly thereafter
Calcium, thyroid and renal function must be monitored every 6 months.
Ensure patient has a Lithium information record card
Lithium treatment care pathway (to be completed before requesting GPs to prescribe
| Pack | Price |
|---|---|
| 150 ml | £6.73 |
Add 150mg - 300mg/day to SSRI/SNRI
Patients can be initiated on modified release formulation but all patients should be considered for a switched to immediate release once an optimal dose is established (see policy below)
Immediate release formulation should be used even though only the modified release formulation is licensed for this indication
If XL is needed for clinical reasons then prescribe by branded generic: Biquelle® XL, Zaluron® XL, Sondate® XL and Mintreleq® XL have the lowest cost. N.B In East Kent GPs are being advised to switch to Sondate® XL
Cost effective use of quetiapine
Plasma concentration monitoring form ONLY for diagnosis of acute poisoning
| Pack | Price |
|---|---|
| 30 tablet | |
| 6 tablet | |
| 60 tablet | £13.84 |
| Pack | Price |
|---|---|
| 2 tablet | |
| 60 tablet | £52.22 |
| Pack | Price |
|---|---|
| 2 tablet | |
| 60 tablet | £61.75 |
| Pack | Price |
|---|---|
| 60 tablet | £51.30 |
| Pack | Price |
|---|---|
| 60 tablet | £73.45 |
| Pack | Price |
|---|---|
| 60 tablet | £67.66 |
| Pack | Price |
|---|---|
| 60 tablet | £113.10 |
| Pack | Price |
|---|---|
| 60 tablet | £113.10 |
| Pack | Price |
|---|---|
| 60 tablet | £170.00 |
| Pack | Price |
|---|---|
| 60 tablet | £226.20 |
Not licensed for this indication but recommended by NICE CG90
Add 5 - 20mg/day to antidepressant
Prescribers are reminded to be alert to the risk of addictive gambling and other impulse control disorders. It is important to advise patients, their families and friends to be alert to these risks.
Plasma concentration monitoring form ONLY for diagnosis of acute poisoning
| Pack | Price |
|---|---|
| 28 tablet | £1.12 |
| Pack | Price |
|---|---|
| 28 tablet | £1.18 |
| Pack | Price |
|---|---|
| 28 tablet | £1.29 |
| Pack | Price |
|---|---|
| 28 tablet | £11.09 |
| Pack | Price |
|---|---|
| 28 tablet | £78.06 |
| Pack | Price |
|---|---|
| 28 tablet | £78.06 |
| Pack | Price |
|---|---|
| 150 ml | £100.72 |
Not licensed for this indication but recommended by NICECG90
Add 10mg to 40mg fluoxetine daily
May also be effective in combination with a tricyclic
Plasma level reduced by up to 50% by cigarette smoke
Recommended dose initially 10mg adjusted as necessary to 5 - 20mg
Plasma concentration monitoring form ONLY for diagnosis of acute poisoning
| Pack | Price |
|---|---|
| 28 tablet | £6.91 |
| Pack | Price |
|---|---|
| 28 tablet | £15.00 |
| Pack | Price |
|---|---|
| 28 tablet | £12.10 |
| 56 tablet |
| Pack | Price |
|---|---|
| 28 tablet | £35.87 |
| 56 tablet |
| Pack | Price |
|---|---|
| 28 tablet | £26.35 |
| Pack | Price |
|---|---|
| 28 tablet | £46.50 |
| Pack | Price |
|---|---|
| 28 tablet | £20.18 |
| Pack | Price |
|---|---|
| 28 tablet | £34.83 |
| Pack | Price |
|---|---|
| 28 tablet | £34.81 |
| Pack | Price |
|---|---|
| 28 tablet | £49.74 |
| Pack | Price |
|---|---|
| 28 tablet | £37.24 |
| Pack | Price |
|---|---|
| 28 tablet | £66.76 |
| Pack | Price |
|---|---|
| 28 tablet | £58.01 |
| Pack | Price |
|---|---|
| 28 tablet | £96.14 |
Not licensed for this indication but recommended by NICE
Add 2-20mg/day to antidepressant
| Pack | Price |
|---|---|
| 20 tablet | £0.59 |
| Pack | Price |
|---|---|
| 20 tablet | £0.61 |
| 6 tablet | |
| 60 tablet |
| Pack | Price |
|---|---|
| 60 tablet | £1.28 |
| Pack | Price |
|---|---|
| 20 tablet | |
| 60 tablet | £1.55 |
| Pack | Price |
|---|---|
| 20 tablet | |
| 60 tablet | £1.72 |
| Pack | Price |
|---|---|
| 28 tablet | £3.04 |
| 30 tablet | |
| 60 tablet |
| Pack | Price |
|---|---|
| 100 ml | £4.10 |
| Pack | Price |
|---|---|
| 28 tablet | £23.86 |
| Pack | Price |
|---|---|
| 28 tablet | £24.02 |
| Pack | Price |
|---|---|
| 28 tablet | £44.43 |
| Pack | Price |
|---|---|
| 28 tablet | £43.49 |
| Pack | Price |
|---|---|
| 28 tablet | £50.35 |
Not licensed for this indication but approved for this use by the trust
Recommended dose 200mg - 400mg daily added to an antidepressant
Plasma concentration monitoring form ONLY for use before and during pregnancy
| Pack | Price |
|---|---|
| 14 tablet | |
| 21 tablet | |
| 30 tablet | |
| 42 tablet | |
| 56 tablet | £1.11 |
| 60 tablet |
| Pack | Price |
|---|---|
| 14 tablet | |
| 30 tablet | |
| 42 tablet | |
| 56 tablet | £1.41 |
| Pack | Price |
|---|---|
| 30 tablet | |
| 56 tablet | £1.49 |
| Pack | Price |
|---|---|
| 30 tablet | |
| 56 tablet | £2.44 |
| Pack | Price |
|---|---|
| 28 tablet | £6.03 |
| 30 tablet | |
| 56 tablet |
| Pack | Price |
|---|---|
| 28 tablet | |
| 30 tablet | |
| 56 tablet | £1.84 |
| Pack | Price |
|---|---|
| 56 tablet |
| Pack | Price |
|---|---|
| 30 tablet | |
| 56 tablet | £3.30 |