The First Antidepressant Trial — Adequate Dose, Adequate Duration, Inadequate Result
Placeholder lead: defines an adequate trial and why many first attempts fall short.
- 6–8 wks: Adequate trial length (placeholder caption)
- ~50–60%: First-line response rate (placeholder caption)
- ~37%: Remission rate (STAR*D step 1) (placeholder caption)
- SSRI: Common first-line class (placeholder caption)
What counts as an adequate trial
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Why response is judged at 6–8 weeks
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Second Trial, Different Class — Two Failures Define Treatment Resistance
Placeholder lead: switching class and confirming TRD after two failed trials.
- 2+ trials: TRD definition threshold (placeholder caption)
- ~31%: STAR*D step 2 remission (placeholder caption)
- ~50%: Cumulative remission after 2 steps (placeholder caption)
- Cross-class: Typical switch strategy (placeholder caption)
Defining treatment-resistant depression
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Switch vs. augment decision point
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Adding Lithium — Enhancing Serotonergic Antidepressant Effect
Placeholder lead: lithium augmentation mechanism and evidence base.
- ~40–50%: Response rate added (placeholder caption)
- 0.6–0.8 mEq/L: Typical serum target (placeholder caption)
- 2–4 wks: Onset of benefit (placeholder caption)
- Levels, TSH, Cr: Monitoring needed (placeholder caption)
Proposed serotonergic mechanism
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Dosing and monitoring considerations
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Low-Dose Atypical Antipsychotic Augmentation, or Combining Two Antidepressants
Placeholder lead: aripiprazole-type augmentation vs. complementary dual-antidepressant strategy.
- ~45–55%: Aripiprazole response add (placeholder caption)
- 2–10 mg: Typical low dose range (placeholder caption)
- SSRI + bupropion: Combination example (placeholder caption)
- Several: FDA-approved adjuncts (placeholder caption)
Atypical antipsychotic augmentation
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Combining complementary antidepressants
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Response Rates Across the Ladder — and What Comes Next
Placeholder lead: cumulative response and the handoff to ECT, ketamine, or TMS.
- ~65%: Cumulative response (placeholder caption)
- ECT/ketamine/TMS: If augmentation fails (placeholder caption)
- 4: Steps modeled here (placeholder caption)
- Outside this page: Next-tier scope (placeholder caption)
Cumulative response across steps 1–4
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When to escalate beyond augmentation
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