Brief Answer: Hike up Cymbalta and also augment. Detailed Answer: Hi XXXXXXX Welcome to Healthcare Magic! It appears that your depression has continued for more than a few months now and you have tried many medicines without complete remission. Since you have found some benefit with Cymbalta (duloxetine), in my opinion, it should be continued but at a higher dose for maximum response. Your dose can be hiked to 120 mg per day in two divided doses if your doctor agrees. This dose has been tried in many studies and found to be safe. If even hiking the dose does not bring you remission from depression, then a combination of drugs should be tried. The response from duloxetine can be augmented by adding other antidepressants like trazodone, mirtazapine or tricyclic antidepressants like amitryptiline, depending on what is likely to suit you. Another policy is to add lithium, buspirone or thyroid hormone to augment the anti-depressant. It is usually seen that addition of an augmenting agent helps in controlling depression and attaining remission. If you wish you can start cognitive behavior therapy or other psychotherapies along with your medicines for better results. If nothing works, there is always the option of electro-convulsive therapy which, in my experience, give miraculous results when everything else has failed. Apart from adding a second drug, there is also the option of switching from duloxetine to other anti-depressants that you have not tried so far. Zoloft, Paxil or Lexapro may be tried. But since you mention that duloxetine has brought you some relief, I feel that it would make sense to continue it and try to augment its response. I hope this helps you. Please feel free to ask if you need any clarifications. Best wishes. Dr Preeti Parakh MD Psychiatry

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Brief Answer: Explained below. Detailed Answer: Hi XXXXXXX As I mentioned earlier, Cymbalta (duloxetine) can be hiked up to 120 mg per day. Augmentation is a strategy used for deriving the best possible response from an anti-depressant. It is done by adding a second drug to the anti-depressant, which may be: a) another antidepressant with a different mode of action, like trazodone, mirtazapine, tricyclic antidepressant etc b) lithium or lamotrigine c) buspirone d) thyroid hormone e) antipsychotic medicines in low dosage Augmentation can be considered if hiking the dose of Cymbalta is not enough. Best wishes. Dr Preeti Parakh MD Psychiatry

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