Psychiatria pre prax 4/2003

Combination of antidepressants in clinical practice

Consequences of availability of new antidepressants are not completely mapped. In the case of unsuccessful first treatment cure, most frequently SSRI, there are four possibilities: dose increase, augmentation, switch to another antidepressant (of the same or other class) and combination of antidepressants. The combination is used in partial responders for reduction of residual symptoms and correction of side effects of AD and a breakthrough of pharmacoresistance. For application of AD combination the theoretical knowledge about mechanism of efficacy and various pressures – from the site of patients, its family, financial reasons are important. There have been realised minimum controlled studies concerning to this problem. The combination of SSRI with another antidepressant is one the most often used, also by primary care doctors. From the theoretical and practical point of view the most justified it is the combination of SSRI and receptor modulators. One from possible risks is the serotonin syndrome.

Keywords: combination of antidepressants, residual symptoms, side effects, pharmacoresistant depression, dual action antidepressants, serotonin syndrome.