Antiepileptic Drug Augmentation for Treatment-Resistant Depression

Letter to the Editor

Sir: The recent case report by Ketter, Callahan, and Post1 illustrating
a positive therapeutic drug/drug interaction for
treatment-resistant anxious depression is an example of outstanding
psychopharmacologic strategizing. The authors explain
their successful outcome, achieved when nefazodone was
added to alprazolam, with a pharmacokinetic model, hypothesizing
that nefazodone extended the duration of action of alprazolam
through inhibiting its degradation by the cytochrome
P450 3A3/4 system, thereby eliminating "interdose dysphoria."