BACKGROUND Pharmacological augmentation is a recommended strategy for patients with treatment-resistant depression (TRD). A range of guidelines provide advice on treatment selection, prescription, monitoring and discontinuation, but variation in the content and quality of guidelines may limit the provision of objective, evidence-based care. This is of importance given the side effect burden and poorer long-term outcomes associated with polypharmacy and TRD. This review provides a definitive overview of pharmacological augmentation recommendations by assessing the quality of guidelines for depression and comparing the recommendations made. METHODS A systematic literature search identified current treatment guidelines for depression published in English. Guidelines were quality assessed using the AGREE II tool. Data relating to the prescription of pharmacological augmenters were extracted from those developed with sufficient rigour, and the included recommendations compared. RESULTS 1696 records were identified, 19 guidelines were assessed for quality, and 10 were included. Guidelines differed in their quality, the stage at which augmentation was recommended, the agents included, and the evidence base cited. Lithium and atypical antipsychotics were recommended by all 10, though the specific advice was not consistent. Of the 15 augmenters identified, no others were universally recommended. CONCLUSIONS This review provides a comprehensive overview of current pharmacological augmentation recommendations for major depression and will support clinicians in selecting appropriate treatment guidance. Although some variation can be accounted for by date of guideline publication, and limited evidence from clinical trials, there is a clear need for greater consistency across guidelines to ensure patients receive consistent evidence-based care.

中文翻译：

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单相抑郁的药理学增强：指南指南。

背景药物增强是治疗难治性抑郁症 (TRD) 患者的推荐策略。一系列指南提供了关于治疗选择、处方、监测和停药的建议，但指南内容和质量的差异可能会限制客观、循证护理的提供。鉴于与多药治疗和 TRD 相关的副作用负担和较差的长期结果，这很重要。本综述通过评估抑郁症指南的质量并比较所提出的建议，对药理学增强建议提供了明确的概述。方法 系统性文献检索确定了当前以英文出版的抑郁症治疗指南。使用 AGREE II 工具对指南进行质量评估。与药理增强剂处方相关的数据是从那些足够严格的数据中提取的，并比较了所包含的建议。结果 确定了 1696 条记录，对 19 条指南进行了质量评估，其中 10 条被纳入。指南的质量、推荐增强的阶段、包括的药物和引用的证据基础各不相同。尽管具体建议并不一致，但所有 10 人都推荐了锂和非典型抗精神病药。在确定的 15 个增强器中，没有其他人被普遍推荐。结论 本综述全面概述了当前针对重度抑郁症的药物增强建议，并将支持临床医生选择合适的治疗指南。