While combining two or more antidepressants is reported to
be commonplace in practitioner surveys in many countries, there
is only level 2 evidence to support this strategy for patients who
do not respond adequately to antidepressant monotherapy. The
best available evidence is for add-on treatment with mirtazapine
or bupropion.
A study conducted by Rush et al. (2011) evaluated the
effectiveness of first-line strategies. They examined two medication
combinations versus SSRI monotherapy over a 7 month
period, in which remission was defined through the use of the
16-item Quick Inventory of Depressive Symptomatology—SelfReport.
Combination medication in this study was bupropion
plus escitalopram and venlafaxine plus mirtazapine, versus