I have major depressive disorder. Will psychotherapy with drugs help?

Question

Hello doctor,

I am 27 and have been dealing with major depressive disorder for over two years. I have tried Sertraline and Escitalopram with limited success, and I am currently on Bupropion 150 mg.

My PHQ-9 score last week was 18. I still feel unmotivated and emotionally flat. My psychiatrist is considering augmenting with Aripiprazole or switching to an SNRI. But I am concerned about side effects and whether the new plan will actually make a difference.

How do doctors decide on next steps when depression is resistant to first-line treatment?
Are combination strategies more effective?
Would psychotherapy, like CBT, help me in this phase if I am already on medication?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

So when depression does not improve adequately with first-line antidepressants, doctors usually follow what is called a “treatment-resistant depression” approach, which means systematically trying different strategies until significant improvement is achieved.

Options include switching to another class, such as SNRIs (serotonin and norepinephrine reuptake inhibitors) like Venlafaxine or Duloxetine, which target both serotonin and norepinephrine.

Augmenting your current medication with another agent, such as Aripiprazole, Lithium, or sometimes even a second antidepressant, these choices are guided by your symptoms, side effect tolerance, and past medication response.

Combination or augmentation strategies can indeed be more effective for some people, especially when a single medication only brings partial benefit.

Psychotherapy, particularly cognitive-behavioral therapy (CBT), is strongly recommended even in later stages because it can address thought patterns, coping skills, and motivation, often enhancing the effects of medication.

Your psychiatrist will weigh potential benefits against side effects such as Aripiprazole’s risk of weight gain, restlessness, or metabolic changes while also considering your priorities and lifestyle.

Depression management is often about tailoring treatment to the individual, so ongoing honest discussion with your doctor about what is working and what is not is the key.

I hope this helps. Always feel free to reach out at any time. I am always here to help.

Thanks and regards.