Many people walk into treatment for a mental health condition hoping to find the right medication or therapist almost immediately. In some cases, that is exactly what happens, and that is a really positive outcome for everyone involved. However, for a large number of adults, the expectation that one approach will be the full answer can leave people feeling stuck when progress slows down.
The reality is that mental health conditions will, more often than not, require multiple approaches to treat. This is where add-on treatments for conditions like depression and anxiety come in, helping you to improve your current line of treatment. Combination therapy in psychiatry is not a sign that something has gone wrong, but rather what effective treatment looks like.
This page covers exactly what those add-ons look like and what the research says about them, including:
Before getting into any specific strategies, it’s first important to be clear on what an add-on treatment refers to in a clinical setting.Â
You may see it referred to as augmentation or adjunctive therapy, but add-on treatment means introducing a second line of treatment alongside something that is only partially working. The ‘partially’ part is important because it makes it very different from switching treatments entirely.
For example, if your current medication has taken you so far, there’s value in building on the positives rather than completely abandoning it.
This is because each time you start over with a new medication, the chances of reaching full remission can drop, according to research.[1]
If your treatment has helped you, but hasn’t fully resolved the situation, what you’re dealing with here is a common outcome in mental health care. In fact, full remission from a single line of treatment is less common than most people realize. Below, we explore why this is the case.
One of the largest ever trials on depression treatment found that only 36.8% of patients reached full remission on their first antidepressant.[2] For those who needed a second step, the rate dropped to around 30%, and the third and fourth steps showed further reductions.
What this tells us is that people with depression may need more than one strategy to reach their treatment goals. This is exactly why augmentation strategies for depression exist.
Some people misinterpret these kinds of results, however, and believe that the type of depression they have is untreatable or that they’re doing something wrong in treatment.Â
Residual symptoms are not something many consider, but they are something that should be discussed. Even when treatment produces a noticeable improvement, leftover symptoms can still create real problems.
Research found that patients with residual symptoms relapsed around three times faster than those who reached full remission.[3] The same study found that 76% of those with lingering symptoms relapsed during the follow-up period, compared to 25% of those who had fully remitted.[3]
These results are important to understand because they show that going from “better” to “well” has genuine consequences for how likely the condition is to return.
It’s also worth noting that different symptoms respond to different types of treatment. For example, things like sleep and energy are some of the first things to improve with medication, but areas like rumination can respond better to therapy.
A single mode of treatment may address one set of symptoms while leaving the other untouched, which is why secondary treatments for anxiety disorders and depression are so widely researched.
If your primary treatment is medication, you may be interested to know that adding a second is one of the most studied strategies in psychiatry. Two types of add-on medication have the strongest evidence behind them, and below, we take a closer look at each.
Lithium has the longest track record of any augmentation strategy for depression. A meta-analysis found that 41.2% of patients who had lithium added to their antidepressant responded, compared to 14.4% on a placebo.[4]
Lithium has also been associated with reduced suicide risk, with benefits that few other medication add-ons have been shown to match.[5] But it’s worth noting that despite these benefits, it remains underused. This is because it requires regular blood monitoring, as well as the fact that newer agents have received more marketing attention.
Medications like aripiprazole and brexpiprazole are FDA-approved for use alongside antidepressants in major depression. One study covering 3,480 patients found that adding an atypical antipsychotic nearly doubled the odds of reaching remission compared to placebo.[6]
But there are trade-offs with these types of medications that come in the form of weight gain and metabolic changes. This is something worth discussing with your prescriber so you can compare the potential pros and cons of taking this medication.Â
Treatment augmentation in psychiatry always involves balancing potential benefits against potential side effects, and your prescriber can help you make an informed decision.
Therapy plus medication is one of the most consistently supported treatment strategies in research. For example, one study found that adding psychotherapy to antidepressant medication produced a meaningful additional benefit and was the strongest in conditions like major depression and panic disorder.[7]
The reason this combination works so well comes down to what each approach does best:Â
Adding therapy to medication can also reduce the risk of relapse compared to just medication alone. Research shows that people who received this combination were less likely to relapse over the following months, compared to those who had received just medication alone.[8]
If you’re currently on medication without therapy, or vice versa, speak with your treatment team about combining the two.
AMFM is here to help you or your loved one take the next steps towards an improved mental well-being.
Aside from medication and psychotherapy, there are several alternative mental health treatments for adults with genuine research behind them that could be considered in your treatment plan. Below, we take a closer look at some of the non-traditional add-ons that may be available to you.
TMS is one of the more advanced psychiatric treatment options available. It uses magnetic pulses to stimulate areas of the brain responsible for mood regulation. It doesn’t require any form of anesthesia and has been FDA-cleared for treatment-resistant depression since 2008.
Research on TMS as adjunctive therapy found that adding it to antidepressant medication produced a response rate of 46.6% of those in the study.[9]
A newer, more updated version called Stanford Neuromodulation Therapy was trialed over a five-day course and found a 52.5% reduction in depression severity.[10]
It’s worth noting that most of the evidence available for TMS is in people who have already tried and not responded to at least one antidepressant. It’s a great option for that group, but it’s not typically used as an add-on for someone who has partially responded to their first medication.
Esketamine is a medication that has received a lot of attention over the past few years, and with good reason. The drug, which contains ketamine, is a nasal spray that has been FDA-approved since 2019.
Data from trials showed promising results with response rates of 53.2% compared to 36.4% with a placebo. Remission rates were also high when esketamine was used, with data showing 38.5%.[11]
The standout feature of esketamine is how fast the medication works, compared with traditional antidepressants. Reports show that it can produce changes within a few hours, whereas traditional antidepressants can take weeks to begin working efficiently.
We all know how important exercise is for our physical health, but it also has a strong evidence base as one of the holistic mental health add-on therapies with real data behind it.Â
A meta-analysis found that activities such as walking or strength training produced noticeable effects on the symptoms of depression.[12]
This isn’t to say that exercise is in any way a standalone cure, and it usually works best in conjunction with clinical treatment.Â
MBCT is a form of therapy that was designed to prevent depressive relapse in those who had already recovered from the condition. The main focus is teaching you ways to prevent depressive relapse, but there’s also a focus on breaking the negative thought processes that led you to depressive thoughts in the past.Â
Data shows it works, too, with roughly 31% who underwent MBCT showing a reduction in the risk of depressive relapse.[13]
The benefit was largest for people who still had residual symptoms after their initial treatment, which connects directly to the earlier point about why getting from “better” to “well” matters so much.
Reading about these options is one thing, but bringing them up with your prescriber or therapist can feel like a different challenge entirely. You might worry about overstepping or coming across as though you’re telling them how to do their job, but the reality is that most clinicians welcome these conversations.Â
Research on shared decision-making in mental health has consistently found that involving patients in treatment decisions improves engagement and satisfaction with care.[14]
A practical way to approach it is to bring a written list of what’s improved since starting treatment and what hasn’t.Â
A quality clinician will be more than happy to go through the list with you and provide details, and possibly even evidence to show you what has and hasn’t worked.Â
If you’ve tried two or more of the strategies covered on this page, and nothing has produced the results you were hoping for, it may be a sign that your current treatment setup needs to be changed.
Outpatient care has limits in terms of how many interventions can be coordinated at the same time, especially if they involve different providers in different locations.
Combination mental health treatment plans delivered through residential or intensive outpatient programs can deliver several evidence-based approaches simultaneously.
These settings allow clinicians to coordinate medication management and therapy more closely while also monitoring your responses to treatment in real-time.Â
A Mission For Michael (AMFM) provides treatment for adults experiencing various conditions. Mental Health support is a phone call away – call 866-478-4383 to learn about our current treatment options.
See our residences in Southern California’s Orange County & San Diego County.
Take a look at our homes on the east side of the Metro area in Washington County.
View our facilities in Fairfax County, VA within the DC metro area.
If your current treatment plan has been beneficial, but you’ve noticed a plateau, the next step is to explore the reasons behind this. The conversation about using adjunctive treatment strategies, or re-evaluating your current setup entirely, is a conversation that’s worth having sooner, rather than later.
AMFM (A Mission For Michael) Mental Health Treatment provides mental health care for adults dealing with conditions like:
Our experienced clinical team works with people whose treatment histories include partial responses and works with you to find the correct next step.
We offer residential programs for those who need a full-time therapeutic environment, along with intensive outpatient options for those who need flexibility around their daily responsibilities. We personalize your treatment plan so you can achieve lasting, life-changing outcomes.
Our locations in California, Minnesota, and Virginia accept insurance and are in-network with most major providers. To check your insurance coverage for mental health care, simply complete our confidential online verification form. A caring member of our team will reach out to you to go over your benefits and discuss treatment options.
If you’ve been wondering whether there’s something that could be added to what you’re already doing, call us today at 866-478-4383. AMFM Mental Health Treatment’s admissions team can talk through your situation and help you work out what makes sense as a next step.
100% Confidential
No Commitment
Instant Results
At AMFM, we strive to provide the most up-to-date and accurate medical information based on current best practices, evolving information, and our team’s approach to care. Our aim is that our readers can make informed decisions about their healthcare.
Our reviewers are credentialed medical providers specializing and practicing behavioral healthcare. We follow strict guidelines when fact-checking information and only use credible sources when citing statistics and medical information. Look for the medically reviewed badge on our articles for the most up-to-date and accurate information.
If you feel that any of our content is inaccurate or out of date, please let us know at info@amfmhealthcare.com
