Walking on thin ice: the use of triple antidepressant combinations in refractory melancholic depression

Abstract

Objective: To report on the outcome of cases of refractory depression treated with a combination of three antidepressant agents. Method: Retrospective case series. Results: Three of the four patients made a good recovery. One patient developed transient increased agitation and exacerbation of pre-existing confusion. Conclusion: The use of a triple antidepressant combination may be a treatment option, albeit unorthodox and inelegant, in very specific circumstances such as for patients with refractory melancholic depression who have only partially responded to vigorous pharmacological treatment with combined antidepressants and are unwilling to use, or are unsuitable for, established treatments, such as lithium augmentation or electro-convulsive therapy (ECT).