Augmentation Strategies for Partial Response to Sertraline

Evidence-Based Recommendations

The American College of Physicians suggests that bupropion is superior to buspirone for augmentation of SSRIs in MDD, with low-quality evidence showing that while response and remission rates are similar, bupropion decreases depression severity significantly more than buspirone 2, 3, 4.
The American Psychiatric Association guidelines indicate that moderate-quality evidence demonstrates that discontinuation due to adverse events is significantly lower with bupropion (12.5%) compared to buspirone (20.6%) when augmenting citalopram, indicating better tolerability 2, 3, 4, 5.
Current OCD guidelines do not recommend buspirone as an augmentation strategy, instead prioritizing antipsychotics (risperidone, aripiprazole), clomipramine, or glutamatergic agents (N-acetylcysteine, memantine) for SSRI-resistant OCD 6.

The National Institute of Mental Health recommends adding CBT with ERP protocol (10-20 sessions) while continuing sertraline 200mg, which addresses all three conditions (MDD, OCD, and GAD) simultaneously 1.
CBT augmentation has lower discontinuation rates due to adverse effects compared to pharmacological augmentation and provides sustained long-term benefits 1.
If CBT is unavailable or declined, the American Medical Association suggests adding bupropion 150mg/day as pharmacological augmentation 1, 5.

Monitor for serotonin syndrome if adding any pharmacological augmentation, particularly in the first 24-48 hours 1.
All antidepressants carry black box warnings for increased suicidal thinking, requiring close monitoring especially during treatment transitions 1.