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Two of three depressed patients respond suboptimally to an initial antidepressant. Studies have suggested little difference between augmenting the antidepressant and switching to another one, but they have rarely studied augmentation with atypical antipsychotics. Despite FDA approval, clinicians employ this approach sparingly. Now, researchers examine the tactic in a Veterans Affairs study involving ≈1500 depressed patients (85% men; mean age, 54; post-traumatic stress disorder, 47%) with limited response to a selective serotonin reuptake inhibitor, serotonin–norepinephrine reuptake inhibitor, or mirtazapine.
Patients were randomized to switching to bupropion, augmentation with bupropion, or augmentation with aripiprazole. At 12 weeks, remis…