Augmentation and Combination Pharmacotherapy Trends: MATERIALS AND METHODS
At the 2005 American Psychiatric Association Annual Meeting in Atlanta, Georgia, an interactive symposium, entitled “Treating Depressive Illnesses: Evidence-Based Updates,” was presented on the topic of the treatment of MDD. One lecturer and co-author (Dr. Schwartz) used an audience-response keypad system to ask the 601-member audience of international psychiatric practitioners about their individual pharmacological practices for their MDD patients.
Figure 1 Results of the following question posed to an audience of psychiatrists at the 2005 APA meeting: “For an initial depressive episode, which antidepressant are you most likely to choose?” Bupro. = bupropion; Misc. = miscellaneous; SNRI = selective serotonin-norepinephrine reuptake inhibitor; SSRI = selective serotonin reuptake inhibitor.
For any single question, it would be expected that 10% of the 601 participants would be non-responders. Ninety percent of the participants in this sample of convenience were prescribing psychiatrists from the U.S. and abroad. Prior to receiving the participants’ responses, the investigator verbally polled the audience members about the frequency with which they used polypharmacy in treating their patients with unipolar depression.
Figure 2 Results of the following question posed to an audience of psychiatrists at the 2005 APA meeting: “For a patient failing [to respond to] initial SSRI treatment in an initial depressive episode, which antidepressant are you most likely to switch to?” Bupro. = bupropion medication ; Misc. = miscellaneous; SNRI = selective serotonin-norepinephrine reuptake inhibitor; SSRI = selective serotonin reuptake inhibitor.
Because of this naturalistic sample, we could not categorize the psychiatrists according to their age, sex, number of years in practice, or other demographic data. There were no a priori research questions, because the data gathered were to be used as a teaching tool. Questions about usual prescribing strategies in treatment-resistant patients were projected on the screen initially (see Results). Subsequently, audience real-time answers were presented on the screen and were used at this symposium as a learning tool during the lecture.
Figure 3 Results of the following question posed to an audience of psychiatrists at the 2005 APA meeting: “If you were to see a patient in his/her third depressive episode who was [using] an SSRI, which FDA-approved antidepressant would you choose to combine for better efficacy?” Bupro. = generic bupropion; Mirt. = mirtazapine drug (tablet Remeron); TCA = tricyclic antidepressant; Misc.= miscellaneous; SNRI = selective serotonin-norepinephrine reuptake inhibitor.
This interactive system was used to increase learning and among symposium participants. It was also designed to share with the audience the tendency toward combination/augmentation strategies in MDD. Participants read the questions and were given about 10 seconds to formulate an answer. The statistical analysis used simple descriptive measures. The percentages of responses are presented in Figures 1 to 4.
Figure 4 Results of the following question posed to an audience of psychiatrists at the 2005 APA meeting:”If you were to see a patient in his/her third depressive episode who was [using] an SSRI,which drug (not FDA-approved for depression) would you choose to augment [therapy] with for better efficacy?” Atyp. = atypical antidepressant; Busp. = buspirone (Buspar); Lamot. = lamotrigine (Lamictal drug); Misc. = miscellaneous; Thy hor. = thyroid hormone.
