Q. I have seen many studies involving SSRI's and agents such as Visken (Pindolol) and BuSpar (Buspirone) to augment antidepressants. Most studies seem very impressing as to the amount of increased efficacy these combinations make.

They additionally seem to improve sexual side-effects and help somewhat with anxiety and the "pooping out" effect of SSRI's, in addition to their helpfulness in alleviating depression.

Is this true? Due these agents work and by what means? Do you augment in your practice, and if so with what agents.

A. Augmentation looks better in articles than it does in real life. While the occasional individual benefits a lot from augmentation, most folks get some better but not as well as they want. There are a host of agents to use as augmenting agents, and the choice depends on what symptoms are left. Anxiety and obsessionality tend to respond well to buspirone, lethargy to stimulants, and anxiety alone to gabapentin. It is best to try and find a single agent that addresses all the symptoms before augmenting. For example, if anxiety persists in the face of eliminated/reduced depression and obsessionality when a patient is on a serotonin reuptake inhibitor, venlafaxine (Effexor) may be a better choice of medication before adding on Neurontin (gabapentin) or BuSpar (buspirone).