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

KMPT lithium policy

NPSA Safer lithium therapy 

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

KMPT lithium policy

NPSA Safer lithium therapy 

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

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