What additional treatment may be added if first-line treatment for major depressive disorder does not work?

In the context of treating major depressive disorder (MDD), if the initial first-line treatment, typically comprising selective serotonin reuptake inhibitors (SSRIs), does not yield the desired improvement in symptoms, it is common practice to consider augmenting the treatment. While SSRIs are often the first-line medication, they can sometimes be insufficient on their own for certain patients.

Adding another SSRI is not a standard approach; instead, clinicians often consider other classes of medications or augmentative therapies. SSRIs can remain part of the treatment regimen while a different class of medications is introduced, but simply increasing or repeating SSRIs tends not to be effective due to similar mechanisms of action. However, additional options for augmenting treatment, such as atypical antipsychotics, mood stabilizers, or even certain stimulants, may be more useful depending on the clinical scenario.

In this context, choosing another SSRI as an augmentation strategy is not typically pursued when first-line treatment fails. It is generally more effective to explore different classes of medications or treatment modalities entirely, rather than risk redundancy with SSRIs. Thus, the option to add another SSRI is less favored compared to alternatives that target different neurochemical pathways or mechanisms of action.