Expert Advice on MDD Treatment: When to Augment or Switch
  • CME

Expert recommendations for when and how to augment or switch treatment for MDD.
Leslie Citrome, MD, MPH
Christoph U. Correll, MD
Rakesh Jain, MD, MPH
Roger McIntyre, MD, FRCPC
Michael E. Thase, MD
Physicians: maximum of 0.25 AMA PRA Category 1 Credits
Released: April 17, 2020 Expiration: April 16, 2021
Interactive Decision Support Tool
MDD Treatment: Augment or Switch?

Learning Objectives

Upon completion of this activity, participants should be able to:
  • Develop patient-tailored treatment plans that include guideline-directed augmentation strategies to manage residual MDD symptoms
  • Incorporate recommended assessment tools in the evaluation of the patient response to antidepressant therapy to guide treatment modification in MDD
  • Summarize the efficacy and safety of atypical antipsychotic therapies used to augment treatment of patients with MDD, especially in the setting of comorbidities such as cardiovascular disease


Disclaimer: Access to and use of this Interactive Decision Support Tool titled, “Expert Advice on MDD Treatment: When to Augment or Switch is provided subject to the following terms and conditions. PLEASE READ THESE TERMS CAREFULLY.

This Interactive Decision Support Tool is designed to educate clinicians on making optimal management choices when advancing treatment for MDD. The information provided is based on expert guidance of Leslie Citrome, MD, MPH; Christoph U. Correll, MD; Rakesh Jain, MD, MPH; Roger McIntyre, MD, FRCPC; and Michael E. Thase, MD.

The material published by Clinical Care Options reflects the views of the reviewers or authors of the CCO material, not those of Clinical Care Options, LLC, the accredited provider, or the companies providing educational grants. The materials may discuss uses and dosages for therapeutic products that have not been approved by the United States Food and Drug Administration. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or using any therapies described in these materials.

Although the information contained in the “Expert Advice on MDD Treatment: When to Augment or Switch” Interactive Decision Support Tool has been produced and processed from sources believed to be reliable, no warranty, expressed or implied, is made regarding the accuracy, adequacy, completeness, legality, reliability, or usefulness of any information. This disclaimer applies to both the isolated and aggregate uses of the information. Clinical Care Options provides this information on an as-is basis. This disclaimer applies to all material published by Clinical Care Options including but not limited to medical information or opinions. All warranties of any kind, expressed or implied, including but not limited to the implied warranties of merchantability, fitness for a particular purpose, freedom from contamination by computer viruses, and noninfringement of proprietary rights are disclaimed.

Any trademarks are the property of respective companies.
© 2020 Clinical Care Options, LLC. All rights reserved.

Information on this Educational Activity

Clinical Care Options, LLC (CCO) requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any relevant conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to CCO policy. CCO is committed to providing its learners with high-quality CME/CE activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME/CE activity:


Roger McIntyre, MD, FRCPC

Professor of Psychiatry and Pharmacology
Department of Psychiatry/Pharmacology
University of Toronto
Head, Mood Disorders Psychopharmacology Unit
Department of Psychiatry
Toronto, Canada

Roger McIntyre, MD, FRCPC, has disclosed that he has received consulting fees and fees for non-CME/CE services from Allergan, Janssen, Lundbeck, Minerva, Neurocrine, Otsuka, Pfizer, Purdue, Shire, Sunovion, and Takeda.
Leslie Citrome, MD, MPH

Clinical Professor
Department of Psychiatry and Behavioral Sciences
New York Medical College
Valhalla, New York

Leslie Citrome, MD, MPH, Acadia, Alkermes, Allergan, Avanir, BioXcel, Eisai, Impel, Indivior, Intra-Cellular Therapies, Janssen, Lundbeck, Luye, Merck, Neurocrine, Noven, Osmotica, Otsuka, Pfizer, Sage, Shire, Sunovion, Takeda, Teva, and Vanda; has served on speaker bureaus for Acadia, Alkermes, Allergan, Janssen, Lundbeck, Merck, Neurocrine, Otsuka, Pfizer, Sage, Shire, Sunovion, Takeda, and Teva; and has ownership interest in Bristol-Myers Squibb, Johnson & Johnson, Lilly, Merck, and Pfizer.
Michael E. Thase, MD

Professor of Psychiatry
Department of Psychiatry
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania

Michael E. Thase, MD, has disclosed that he has received funds for research support from Acadia, Allergan, Axsome, Intracellular, Johnson & Johnson, Otsuka, and Takeda and consulting fees from Acadia, Akili, Alkermes, Allergan, H. Lundbeck, Jazz, Johnson & Johnson, Merck, Otsuka, and Pfizer.
Christoph U. Correll, MD

Professor of Psychiatry and Molecular Medicine
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Hempstead, New York
Medical Director, Recognition and Prevention Program
Department of Psychiatry
The Zucker Hillside Hospital
Glen Oaks, New York

Christoph U. Correll, MD, has disclosed that he has received funds for research support from Janssen/Johnson & Johnson and Takeda; consulting fees from Alkermes, Allergan, Angelini, Gedeon Richter, Gerson Lehrman Group, IntraCellular Therapies, Janssen/Johnson & Johnson, LB Pharma, Lundbeck, MedAvante-ProPhase, Neurocrine, Noven, Otsuka, Pfizer, Recordati, Rovi, Sumitomo Dainippon, Sunovion, Supernus, Takeda, and Teva; fees for non-CME/CE services from Alkermes, Allergan, Angelini, Gedeon Richter, Janssen/Johnson & Johnson, Lundbeck, MedAvante-ProPhase, Otsuka, Pfizer, Recordati, Sumitomo Dainippon, Sunovion, and Takeda.
Rakesh Jain, MD, MPH

Clinical Professor
Department of Psychiatry
Texas Tech Health Sciences Center, School of Medicine
Midland, Texas

Rakesh Jain, MD, MPH, has disclosed that he has received consulting fees from Acadia, Alfasigma, Alkermes, Allergan, Eisai, Evidera, Impel, Janssen, Lilly, Lundbeck, Merck, Neos Therapeutics, Neurocrine, Osmotica, Otsuka, Pamlab, Pfizer, Shire, Sunovion, Supernus, Takeda and Teva; fees from non-CME/CE services from Alkermes, Allergan, Ironshore Pharmaceuticals, Janssen, Lilly, Lundbeck, Merck, Neos Therapeutics, Neurocrine, Otsuka, Pamlab, Pfizer, Shire, Sunovion, Takeda, Teva and Tris Pharmaceuticals; and funds for research support from Allergan, Lilly, Lundbeck, Otsuka, Pfizer, Shire, and Takeda; and that his spouse/partner has received consulting fees from Lilly, Otsuka, Pamlab, and Sunovion and fees for non-CME/CE services from Lilly.


Zachary Schwartz, MSc

Scientific Director

Zachary Schwartz, MSc, has no relevant conflicts of interest to report.
Anne Roc, PhD
Director, Scientific Services
Anne Roc, PhD, has no relevant conflicts of interest to report.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.


Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Target Audience

This activity is intended primarily for psychiatrists and primary care physicians who care for patients with MDD.


The goal of this activity is to improve the learner’s competence in selecting treatment augmentation modalities (eg, dosage changes, antidepressant switching, adding atypical antipsychotic) for patients with MDD who respond suboptimally to antidepressant therapy.


Joint Accreditation Statement

In support of improving patient care, Clinical Care Options, LLC (CCO) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Credit Designation

CCO designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Program Medium

This program has been made available online.

Instructions for Credit

Participation in this self-study activity should be completed in approximately 0.25 hours. To successfully complete this activity and receive credit, participants must follow these steps during the period from April 17, 2020, through April 16, 2021:

1. Register online at
2. Read the target audience, learning objectives, and faculty disclosures.
3. Enter patient details and submit case.
4. Review the patient case online or printed out.
5. Submit answers to the Clinical Implications questions and evaluation questions online.

You must respond to all Clinical Implications and evaluation questions to receive credit. After submitting the evaluation, you may access your online certificate by selecting the certificate link on the posttest confirmation page. Records of all CME/CE activities completed can be found on the "CME/CE Manager" page. There are no costs/fees for this activity.

Related Content

Concise CME on managing common comorbidities in patients with MDD, including obesity, cardiovascular disease, and substance use disorder

Christoph U. Correll, MD Physicians: maximum of 1.0 AMA PRA Category 1 Credit Released: April 13, 2020 Expired: April 12, 2021

Free CME from CCO and Roger McIntyre, MD, FRCPC: Expert insights on guideline-based treatment augmentation for MDD

Roger McIntyre, MD, FRCPC Physicians: maximum of 1.0 AMA PRA Category 1 Credit Released: February 26, 2020 Expired: February 25, 2021
Provided by Clinical Care Options, LLC

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Supported by an educational grant from
Otsuka and Lundbeck Alliance

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