By Tannia Salazar, APRN | Rooted in Serenity Behavioral Health 🌿

For many people, first-line antidepressants like SSRIs or SNRIs bring meaningful relief. But for others, symptoms linger despite multiple trials. This is sometimes called treatment-resistant depression (TRD).

TRD does not mean you’re out of options. Instead, we may consider augmentation strategies — carefully adding another medication to strengthen the effect of your antidepressant and address stubborn symptoms.

What Does Augmentation Mean?

Rather than switching to a brand-new antidepressant, augmentation means adding a second medication that works in a different way. This approach can help improve:

Low energy or motivation
Difficulty focusing or concentrating
Trouble sleeping
Persistent anxiety

Common Augmentation Medications

Here are some medications often considered when depression or anxiety doesn’t fully respond to first-line treatment:

Rexulti (brexpiprazole) – FDA-approved add-on for major depression; can improve mood, energy, and anxiety.
Abilify (aripiprazole) – another add-on option that boosts antidepressant effects, often helping with motivation and mood stability.
Lamotrigine (Lamictal®) – may reduce depressive symptoms and emotional reactivity; useful when mood feels unstable.
Quetiapine (Seroquel®) – sometimes prescribed at low doses for depression and anxiety, especially when insomnia is also present.
Buspirone (Buspar®) – gentle, non-addictive option often used as an add-on for generalized anxiety disorder.
Trazodone (low dose) – not a primary antidepressant, but may be added to improve sleep quality when mood and anxiety disrupt rest.

Who Might Benefit from Augmentation?

Your provider may suggest augmentation if:

You’ve tried at least two antidepressants without full relief
You notice partial benefit, but symptoms like fatigue, poor sleep, or anxiety persist
You’re struggling with focus or low motivation despite treatment
You want to avoid restarting the trial-and-error cycle of switching medications

Common Side Effects

All medications can cause side effects, though many are mild and improve over time. Here’s what patients commonly notice with augmentation medications:

Medication	Possible Side Effects	What to Expect / When to Reach Out
Rexulti	Restlessness, weight gain, drowsiness	Often mild; call if movement feels uncontrollable or weight changes are rapid
Abilify	Jitteriness, insomnia, stomach upset	May improve with dose adjustment; call if severe or persistent
Lamotrigine	Headache, dizziness, skin rash	Call right away if new rash develops (rare but important)
Quetiapine	Drowsiness, weight gain, dry mouth	Helpful for sleep at low doses; call if sedation is too strong
Buspirone	Dizziness, nausea, lightheadedness	Usually mild and fade with time; take consistently for best effect
Trazodone (low dose)	Drowsiness, morning grogginess, dry mouth	Typically improves sleep; call if excessive sedation occurs

Final Thought

If antidepressants alone haven’t been enough, augmentation strategies can provide new hope. By adding targeted medications like Rexulti, Abilify, Lamotrigine, or Buspirone, we can address persistent symptoms and support both mood and anxiety.

You are not out of options. At Rooted in Serenity Behavioral Health, I, Tannia Salazar, APRN, will work with you to find the safest, most effective combination — personalized to your symptoms, your health, and your goals.

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