What is Augmenting in Medical Treatment?
Augmenting (or augmentation therapy) refers to adding a second medication to an existing treatment regimen to enhance or boost its effectiveness, rather than replacing the original medication. This strategy is most commonly employed when a patient has not responded adequately to first-line therapy alone.
Context-Specific Definitions
In Alpha-1 Antitrypsin (A1AT) Deficiency
Augmentation therapy specifically means intravenous infusion of purified human alpha-1 antitrypsin concentrate to correct the protein deficiency and prevent further lung destruction 1. This is the primary disease-modifying treatment for A1AT deficiency-related emphysema.
Key characteristics of A1AT augmentation:
- Mechanism: Replaces the deficient A1AT protein through IV infusion of plasma-derived concentrate
- Goal: Increase antineutrophil elastase capacity in lung tissue to 60-70% of normal levels
- Dosing: Typically 60 mg/kg body weight weekly, though monthly dosing at higher concentrations is also used
- Eligibility criteria 2:
- Serum A1AT levels <11 mmol/L (0.57 g/L)
- FEV1 <80% predicted with CT evidence of emphysema
- Non-smoker for at least 6 months
- No prior lung transplant
Evidence supports that augmentation therapy slows lung density decline and may reduce mortality, particularly in patients with moderate emphysema (FEV1 31-65% predicted) 1. The most recent Canadian guidelines 2 recommend SERPINA1 genetic sequencing before starting therapy and emphasize that augmentation should complement—not replace—optimal COPD management including bronchodilators, pulmonary rehabilitation, and smoking cessation.
In Psychiatric Treatment (Depression/Anxiety)
In psychiatry, augmentation means adding a non-antidepressant medication to an existing antidepressant that has produced inadequate response 3, 4, 5. This differs from "combination therapy" where two antidepressants are used together.
Common augmentation agents include:
- Lithium: Best evidence base, particularly with tricyclic antidepressants 4
- Triiodothyronine (T3): Well-supported thyroid hormone augmentation 4
- Atypical antipsychotics (e.g., aripiprazole): Recent evidence in geriatric depression shows aripiprazole augmentation improved well-being more than switching antidepressants 6
- Buspirone, pindolol: Moderate evidence 4, 7
Important caveat: Most augmentation strategies in psychiatry lack robust placebo-controlled trial evidence 3, 5. The strategy aims to achieve different neurochemical effects than the failed antidepressant alone, but carries risks of drug-drug interactions and additive adverse effects 7.
Key Distinction from Other Strategies
Augmentation differs from:
- Switching: Stopping one medication and starting another
- Combination therapy: Using two medications of the same class together (e.g., two antidepressants)
The rationale for augmentation over switching is preserving any partial benefit already achieved from the initial medication while adding complementary mechanisms of action 5.