Objective: The aim of this study was to survey doctors working in psychiatry in Australia about the practice of using two antidepressants simultaneously.
Method: A postal survey was sent to all doctors in psychiatry in Australia enquiring about their prescribing history and their attitudes to combination antidepressants and related issues.
Results: Seventy-nine percent of respondents had used combination antidepressants. The most frequently reported combination was a selective serotonin reuptake inhibitor combined with a tricyclic antidepressant. Combinations of mirtazepine with venlafaxine and other antidepressants were the next most frequently used. Seventeen percent of respondents reported having seen a complication from combination antidepressants, 75% believed that Australian GPs should be given information on the use of combination antidepressants, 89% wished for more information on this topic, and 88% believed patients had a right to be informed of this option in their treatment. Use of combination antidepressants was more frequent than exceeding the recommended maximum dose of an individual antidepressant.
Conclusion: Combination antidepressants are used far more frequently in Australia than suspected previously. Research into safe and evidence-based practice is strongly indicated.
HendersonSAndrewsGHallW. Australia's mental health: an overview of the general population survey. Australian and New Zealand Journal of Psychiatry2000; 34: 197–205.
2.
HirschfeldRMSchatzbergAF. Long-term management of depression. American Journal of Medicine1994; 97: 33S–38S.
3.
BertoloteJMFleischmannADe LeoDWassermanD. Psychiatric diagnoses and suicide: revisiting the evidence. Crisis2004; 25: 147–155.
4.
LamRWWanDDCohenNLKennedySH. Combining antidepressants for treatment-resistant depression: a review. Journal of Clinical Psychiatry2002; 63: 685–693.
5.
NelsonJCMazureCMJatlowPIBowersMBJrPriceLH. Combining norepinephrine and serotonin reuptake inhibition mechanisms for treatment of depression: a double-blind, randomized study. Biological Psychiatry2004; 55: 296–300.
6.
FerreriMLavergneFBerlinIPayanCPuechAJ. Benefits from mianserin augmentation of fluoxetine in patients with major depression non-responders to fluoxetine alone. Acta Psychiatrica Scandinavica2001; 103: 66–72.
7.
MaesMLibbrechtIvan HunselFCampensDMeltzerHY. Pindolol and mianserin augment the antidepressant activity of fluoxetine in hospitalized major depressed patients, including those with treatment resistance. Journal of Clinical Psychopharmacology1999; 19: 177–182.
8.
TrivediMHFavaMWisniewskiSR. Medication augmentation after the failure of SSRIs for depression. New England Journal of Medicine2006; 354: 1243–1252.
9.
DoddS, HorganD, MalhiGS, BerkM. To combine or not to combine? A literature review of antidepressant combination therapy. Journal of Affective Disorders. 2005; 89: 1–11.
10.
FavaM, RushAJ, TrivediMH, . Background and rationale for the sequenced treatment alternatives to relieve depression (STAR∗D) study. Psychiatric Clinics of North America2003; 26: 457–494.
11.
StahlSM. Essential Psychopharmacology: Neuroscientific Basis and Practical Applications. Cambridge University Press, Cambridge2000.
