Advances in Psychiatric Treatment (2009) 15: 90-99. doi: 10.1192/apt.bp.107.004820
© 2009 The Royal College of Psychiatrists
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Combining antidepressants: a review of evidence

Lena Palaniyappan, Lisa Insole and Nicol Ferrier

Lena Palaniyappan is Academic Clinical Fellow at the Division of Psychiatry, Newcastle University, and Specialty Training Registrar for the North East Regional Affective Disorders Service. His research interests include neuroimaging and cognitive neurobiology. Lisa Insole is a Specialist Registrar, also in the North East Regional Affective Disorders Service. Her interests include early intervention in psychosis, psychotherapy and postgraduate teaching. Nicol Ferrier is Professor of Psychiatry at the Institute of Neuroscience, Newcastle University, and Honorary Consultant Psychiatrist for Newcastle, Tyne and Wear Mental Health NHS Trust. He works in a clinical capacity for the North East Regional Affective Disorders Service. His research interests are in psychopharmacology and the neurobiology and treatment of severe affective disorders. He was on the National Institute for Health and Clinical Excellence (NICE) guidelines group for unipolar depression and chaired the NICE guidelines group for bipolar disorder.

Correspondence: Correspondence Professor Nicol Ferrier, Institute of Neuroscience, Newcastle University, Leazes Wing, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK. Email: i.n.ferrier{at}ncl.ac.uk

Sequenced (stepped) treatment approaches are widely endorsed in the management of depression. Combining antidepressants is a recognised step for those failing to respond to monotherapy. Despite the limited evidence base, this strategy is widely used by clinicians in practice. Not every combination used clinically has a sound neuropharmacological rationale and the use of such combinations may increase the side-effect burden without any additional advantage to the patient. Efficacy of various antidepressant combinations along with the data on side-effect profile and toxicity of such combined treatments are reviewed here. The different combinations are considered by each class of antidepressant available in the UK.




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