Published online Sep 22, 2015. doi: 10.5498/wjp.v5.i3.330
Peer-review started: May 19, 2015
First decision: July 10, 2015
Revised: July 28, 2015
Accepted: August 20, 2015
Article in press: August 21, 2015
Published online: September 22, 2015
Core tip: According to the available evidences and our personal experience we suggest to treat patients non-responders: to one selective serotonin reuptake inhibitors antidepressants (SSRI), buproprion or mirtazapine trial by switching to venlafaxine; to one venlafaxine trial by switching to tricyclic antidepressants (TCA) or, if TCA are not tolerated, by combining mirtazapine with SSRI or venlafaxine; to two or more adequate antidepressant (AD) trials (including TCA if tolerate) by AD augmentation with lithium (mainly in patients with bipolar depression or suicidality), second generation antipsychotics (SGAs) (mostly aripiprazole) or dopamine-agonists (mostly pramipexole); to combination and augmentation strategies and elettroconvulsive therapy (ECT), if workable, by combination plus augmentation strategy. Combining the available evidences and our personal experience we suggest: for non-responders to one SSRI (buproprion or mirtazapine) trial switching to venlafaxine for non-responders to one venlafaxine trial switching to TCA, if TCA are not tolerated, combining mirtazapine with SSRI or venlafaxine. For non-responders to two or more AD trials (including TCA if tolerate) we suggest AD augmentation with lithium (bipolar depression or suicidality), SGAs (aripiprazole) or dopamine-agonists (pramipexole) for non-responders to combination and augmentation strategies and ECT, if possible, we suggest a combination plus augmentation strategy.