When to Consider Adjunctive Treatments for Depression

When a patient fails to response to a first-line treatment option for depression, what are the next steps to consider? In this video, Brooke Kempf, MSN, PMHNP-BC, offers her thoughts on how to approach the nuanced decision-making process of augmenting antidepressants, including the timing and considerations for adjunctive treatments like aripiprazole.

Read the transcript:

Brooke Kempf, MSN, PMHNP-BC: Hello, my name is Brooke Kempf. I'm a psychiatric mental health nurse practitioner located in Terre Haute, Indiana at our community mental health center called Hamilton Center. I also teach for Indiana University and Purdue University of Indianapolis, where I teach for our psychiatric mental health health nurse practitioner program.

So, when we ask is it appropriate to use aripiprazole adjunctively, let's broaden that question just looking at adjunctive treatment in general. So not just aripiprazole, but a number of medications that you can use adjunctively in the treatment of depression. We have aripiprazole, brexpiprazole, we have lithium, a multitude of different options whenever you're not getting an optimal response for your patient with major depressive disorder

The first thing to remember is we do not want patients to continue to have ongoing symptoms. We always want to treat to remission. So, you have a patient that is not responding or not having a therapeutic response that we want to to a medication. General guidelines say that we should optimize dose before making changes, but we also want to think about the patient-specific symptoms. If we're talking about a dangerous situation, a patient with very severe depression, or we have an individual that might even be suicidal, you might have to take action sooner. You definitely don't want to wait to make these decisions.

Gone are the days when we used to think of waiting 4 to 6 weeks to see a responsive medication. We want to make general check-ins about 2 to 4 weeks within treatment and continue to check in on your patient to make sure they're having a response. As long as they're having a response, absolutely work towards that optimal dose. And then if you're not to remission, that's when you can use your adjunctive treatment

Because again, we're not going to stop at response--we want to treat to remission.

Brooke Kempf, MSN, PMHNP-BC, has worked as a psychiatric nurse at Hamilton Center in Terre Haute, Indiana since she graduated from Indiana State University in 1996. Her education and experience with medication monitoring, providing care as a group home nurse, managing injection clinics, and providing staff training allowed her to pave the way for the unique outpatient nursing services that have now grown to multiple nursing staff and locations and led to her being awarded with the 2008 Hamilton Award for Outstanding Staff Member. Ms. Kempf obtained her master’s degree from the State University at Stony Brook of New York and is board Certified by the ANCC as a Psychiatric Mental Health Nurse Practitioner. She currently practices as the Hospitalist for the Inpatient Psychiatric Unit of Hamilton Center.