Treatment of Severe Major Depression with Partial Response to Sertraline

Second-Line Strategies: Comparative Evidence

The American College of Physicians shows that different second-line strategies (switching antidepressants, increasing dosage, or augmentation) provide similar symptomatic benefits, but with different adverse effect profiles 1, 2
The American College of Physicians indicates that cognitive-behavioral therapy (CBT) should be considered as an augmentation option after partial response 1, 2
Moderate-quality evidence shows no difference in response when switching from one SSRI to another (bupropion vs. sertralina vs. venlafaxina) 1, 2

Low-quality evidence shows that adding CBT to sertraline produces similar results in response and remission compared to pharmacological augmentation, but with a lower rate of discontinuation due to adverse effects 2
Adding bupropion to sertraline showed a decrease in depression severity compared to buspirona, with lower discontinuation due to adverse effects 1, 2
The combination of pharmacotherapy and psychotherapy is particularly suitable for severe depression 4

For partial response, the first option is to add CBT (10-20 sessions) while maintaining sertraline 100 mg 1, 2
For partial response, the second option is to add bupropion (initiate 150 mg/day) if CBT is not available 1, 2

The American College of Physicians recommends considering CBT as an option for augmentation after partial response 1, 2
Factors that favor augmentation with CBT include availability of a trained therapist 1, patient preference for combined therapy 4, lower risk of adverse effects compared to pharmacological polytherapy 2, and sustained long-term benefits 4