Consider an evidence-based psychotherapy (CBT, IPT, or PST) as an augmentation strategy instead of medication.
If using a medication for augmentation, consider the following:
Step 1. Choose either:
a. Mirtazapine 30 mg po qhs X 2 weeks. If less than 20% response and tolerating it consider increase to 45 mg po qhs or
b. Buproprion XL 150 mg po daily X 2 weeks. If less than 20% response consider and tolerating consider increase to 300 mg po daily
c. If on either Bupropion or Mirtazapine as an initial agent, consider augmenting with an SSRI or an SNRI.
If Step 1 interventions are ineffective or not tolerated, then proceed to Step 2:
Step 2. Choose either:
a. Aripiprazole 2.0 mg daily x 2 weeks. If less than 20% response and tolerating consider increase to 5.0 mg po daily or
b. Quetiapine XR 50 mg at supper x 1 week, then increase to 100 mg x 1 week, then increase to 150 mg. If less than 20% response after 2 weeks then increase to 300 po q supper if tolerated.