Many patients reach a point in their mental health treatment plan where standard medication therapy has not been effective in satisfactorily addressing symptoms. When this happens, sometimes an antidepressant regimen is augmented (or “added to”) but medications that are not classical antidepressant medications, but can offer alternative ways of addressing depressive symptoms.
Among many other medications, Lithium, aripiprazole, or cariprazine may be considered as augmentation agents to be added to your current treatment regimen. Ketamine and esketamine, in this way, is sort of like an augmentation medication – helping alongside other medications. In clinical practice, it’s possible to see these paths used together over time, not as permanent either/or choices.
This guide explains what augmentation medications do, how they differ from in‑clinic ketamine treatment, what to expect for access and logistics, and how people decide.
What these medications do and when they’re used (augmentation after antidepressants)
When a standard antidepressant helps only partway, clinicians often add a second medicine to boost effect. This is called “augmentation.” Some examples of commonly-used augmentation medications are below, but it’s important to note that the list is more comprehensive than the below.
- Lithium is a mood stabilizer that has evidence for reducing relapse risk and augmenting antidepressants in persistent depression. Dosing is individualized with periodic blood tests and monitoring for side effects.
- Aripiprazole is a dopamine‑serotonin modulator used at low doses to augment antidepressant medications. Many patients notice changes in energy, motivation, or anxiety when it helps. It requires monitoring for restlessness or metabolic effects.
- Cariprazine is a dopamine D3/D2 partial agonist that can augment antidepressants in some patients. Monitoring is similar to other atypical antipsychotics.
These medications are taken daily at home. They aim to improve mood, energy, and function by nudging brain signaling toward healthier patterns. They are not quick fixes; their effects are exhibited gradually over time and require daily dosing to maintain benefit.
At‑home meds vs in‑clinic interventional care (daily exposure vs contained sessions)
Augmentation meds live in your daily routine. You take a pill and carry its effects all day, just like standard antidepressant medications. The pros of this are that it’s easy to start treatment (especially when covered by insurance) and monitoring/adjusting dose fits into regular medication appointments, and there are no meaningful changes to a daily routine to take these medications. The cons are that these medications don’t necessarily return the same benefit as ketamine, they must be taken daily, and it can take time to know if the change is working.
Ketamine therapy is different. It is a contained, monitored session on site with medical professionals. At Lumin Health, ketamine treatment is offered in two broad forms:
- Esketamine (Spravato): an FDA‑approved intranasal treatment for treatment‑resistant depression. Spravato treatment happens only in a certified Spravato clinic, with vital sign checks and observation.
- Off‑label ketamine: intramuscular (IM) ketamine dosing at Lumin Health with monitoring. Protocols are tailored to your diagnosis and response.
Many patients prefer that the medicine event happens in a supervised setting with staff present. Others prefer the familiarity of at‑home pills. Either path can be paired with psychotherapy or behavioral support if you choose it.
Efficacy ranges compared with ketamine and Spravato
Both strategies can help people with treatment‑resistant depression. Some differences to consider are:
- Pace of change: Some patients notice early shifts in mood or reactivity within hours to days of starting ketamine/esketamine therapy, particularly during the first few doses. Augmentation meds usually build more gradually across days to weeks.
- Experience: Augmentation medicines do not change consciousness or observed experiences. Ketamine treatment can include short‑term perceptual changes during ketamine dosing, with staff present until you are ready to go home (~2 hours). Many patients describe a brief sense of distance from routine thoughts that fades the same day. These perceptual changes can sometimes be helpful.
- Durability: Both paths may require maintenance. With Spravato, the FDA-approved label includes a taper from weekly to weekly or every other week. Off‑label ketamine often moves to spaced boosters when needed. With augmentation meds, durability is tied to consistent daily use and periodic dose reviews.
No option is a one-size-fits-all for everyone. What matters is whether your functioning improves across weeks: steadier sleep, more good days, and re‑engagement with what matters to you.
Access & insurance: why augmentation is often easier to start than ketamine therapy or Spravato
Why augmentation often starts first
- Coverage: Aripiprazole, lithium, and cariprazine are commonly covered as add‑ons to antidepressants. Lithium requires lab monitoring, which is also usually covered.
- Simplicity: Prescribers can start low and titrate at home without clinic visits.
Access to ketamine therapy
- Spravato treatment is FDA‑approved for treatment‑resistant depression and is often covered when criteria are met. Visits occur at the site of a medical practice, include medical observation, and require a ride home.
- Off‑label ketamine therapy has less predictable coverage. Some patients use out‑of‑network benefits, but most pay out of pocket.
Time costs
- Augmentation meds: standard prescriber visits and pharmacy trips.
- Ketamine treatment: dose days require at least a 2 hour commitment plus travel time.
How people actually choose between augmentation and ketamine therapy
In clinical practice, choices are guided by values, readiness, and support.
- Impact: Ketamine and esketamine work more reliably, more deeply, and more quickly than augmentation medications.
- Values: Do you prefer a familiar pill, or are you open to a monitored in‑clinic experience with short‑term perceptual shifts?
- Readiness for sessions: Can you plan transportation and a quiet evening after Spravato treatment? Would you rather fit a pill into your morning routine?
- Pace vs steadiness: Is faster change the priority, or is a slower, steady approach acceptable right now?
There is no single right order. Many patients try one path, check progress and adjust.
FAQs
Are augmentation meds half as effective as ketamine/esketamine therapy?
No. Ketamine and esketamine are more effective in treating symptoms of major depressive disorder.
Can my psychiatrist prescribe augmentation medications while I’m in Spravato treatment?
Yes. Many patients continue antidepressants and sometimes augmentation meds while receiving ketamine/Spravato treatment. Your prescriber coordinates dosing and monitors for interactions and side effects for augmenting medications.
Will I have to stop augmentation meds if I start ketamine for depression?
No. Decisions are individualized. Some continue medicines, others simplify regimens before or during ketamine for depression. Your team will guide timing.
Which is safer?
They have different risk profiles which makes a question of relative safety complicated to answer. Pre-existing medical conditions also need to be regarded. Keep these conversations going with your providers who can help you navigate your particular circumstance.
A patient‑centered way to move forward
If you’re deciding between augmentation and ketamine therapy, start with assessing your values and current realities either by yourself or with your existing care team. If simplicity and coverage matter most, an augmentation trial may come first. If pace of change is a priority or several trials have not helped, ketamine treatment – including Spravato administered in a certified Spravato clinic – may be worth exploring now. These are not one‑time, irreversible decisions. You can sequence both over time and adjust as you learn what helps.
Lumin Health provides balanced education and careful monitoring for ketamine for depression, including Spravato treatment in our certified Spravato clinic and collaboration with your psychiatrist around augmentation plans. Our aim is a plan that is safe, built around you, and doable.
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