Get more practical learning and clinical tools for mental health and substance-use care in outpatient settings at Collaborative Psychiatry.
An antidepressant has made a real difference, but the patient is still struggling. When there is a benefit worth preserving, the next step may be to add treatment for what symptoms remains rather than start over with a different medication. The useful question is: what change are we hoping the add-on will make?
This episode offers a practical approach to antidepressant augmentation: when it makes sense, how to choose an add-on for a specific goal, and how to tell whether it has earned its place. We discuss bupropion for low energy or SSRI-related sexual side effects, mirtazapine for poor sleep or appetite, and aripiprazole when depression remains disabling. We also address combining antidepressants, mirtazapine dosing, and what to watch for at follow-up.
Visit the episode page for the key clinical takeaways and the downloadable Antidepressant Augmentation clinical reference—a one-page comparison of bupropion XL, mirtazapine, aripiprazole, brexpiprazole, and quetiapine XR, with practical doses, key cautions, and follow-up checks. The download is available with a free Collaborative Psychiatry account.
For the broader approach to diagnosis, medication selection, titration, switching, and augmentation, explore the Managing Depression Clinical Framework. It also discusses other augmentation options, including lithium, T3, and modafinil.
You can also browse more Collaborative Psychiatry QuickTakes.
