Depression Treatment: How to Add ‘Booster’ Meds Without Breaking the Bank

In situations like these, your doctor may suggest an adjuvant medication, also called a booster or add-on, that enhances the effect of your primary medication, says Nabil Siddiqi, MD, a psychiatrist with Orlando Health Medical Group Behavioral Health in Longwood, Florida. What's tricky for many patients isn't just choosing what to use; it's being able to pay for it.

"Booster meds are typically medications that have different mechanisms of action from the initial medications," he says. "There are many factors in making this determination, and cost consideration should always be one of those. A medication that a patient can't afford is of no benefit, because there wouldn't be the ability to use it on a long-term basis."

Fortunately, there are some ways to get the boost you need without breaking the bank. Here are some insights into how boosters are used, along with tips to make them more affordable.

Before delving into cost, it's helpful to look at why you might consider these medications in the first place. It's important to note that a booster isn't a sign your initial medication failed. Your brain's chemistry may necessitate a multipronged approach to get you to remission, says Dr. Siddiqi.

"If a patient has achieved at least a 50 percent response to the initial medication, then augmentation strategies are considered," he says. "Less than 50 percent usually requires a transition to a different medication."

Doctors use screening tools to determine whether you're over or under that 50 percent mark, such as the Hamilton rating scale for depression (HAMD-17) and the patient health questionnaire (PHQ-9), he says.

If you and your healthcare team decide that a booster may be helpful, the next step is deciding which type of medication to try. Different antidepressants work on different brain chemicals, called neurotransmitters, that play a role in mood regulation, including serotonin, norepinephrine, and dopamine. If you’re on a medication that works primarily on one of these, such as a selective serotonin reuptake inhibitor (SSRI), adding a second type of antidepressant may either enhance how the reuptake process works or affect one of the other neurotransmitters.

• aripiprazole (Abilify)
• brexpiprazole (Rexulti)
• bupropion (Wellbutrin)
• buspirone (Buspar)
• quetiapine (Seroquel)
• lithium (Lithobid)
• esketamine (Spravato)
• thyroid hormones

Which you choose will depend on what issues need to be resolved, says Alex Dimitriu, MD, a psychiatrist and the founder of Menlo Park Psychiatry and Sleep Medicine in California and a medical reviewer for Everyday Health.

"Common examples include aripiprazole or lithium to stabilize mood, or thyroid hormone to improve metabolic efficiency," he says. "We also use stimulants or wakefulness-promoting agents if fatigue and brain fog are problematic. Hypnotics or sleep aids can improve sleep. Bupropion is also often used to improve energy and motivation."

As with other types of medications, generic mental health medications can be much cheaper than brand names, says Dr. Dimitriu.

"Generic options like lithium or buspirone are very affordable," he says. “However, newer atypical antipsychotics or branded medications can be expensive, which can definitely limit access for some patients depending on their insurance coverage.”

What you actually pay depends on the type of insurance coverage you have. Your pharmacist can tell you what your out-of-pocket costs will be, or you can call your insurance company or check their website.

If a prescribed medication isn't covered by your insurance, that doesn't always mean you automatically have to pay the full cost. There are some strategies that can lower your out-of-pocket amount.

Drug Company Assistance Programs

Discount Tools

Several sites offer coupon cards for pharmaceuticals, such as GoodRx, SingleCare, Cost Plus Drugs, and WellRx, and these can help you find deals, says Nissa Keyashian, MD, a psychiatrist in private practice in San Jose, California. These tools are free to use, and create a digital or physical coupon you can take to a pharmacy to get a lower cost on a specific medication.

Shop Around

Most of all, don't be afraid to shop around and to ask your health provider for advice, since they frequently see patients trying to navigate insurance and prescription costs during treatment, says Dr. Keyashian.

"Always check with online sites for coupons, as well as the cost at different pharmacies, since there can be a considerable difference even with the same medication," she says. "I've had patients pay $400 for a medication at one pharmacy that they could have gotten from another in the same town for $10."

Although there are instances where you might not be able to get a certain booster due to cost, there are usually other effective medications that are more affordable, she says. It might take some effort, research, and time to find a solution that’s the right fit for your condition — and your budget.

• With major depressive disorder, you may need an additional medication if you're feeling stalled in your treatment.
• A booster medication can often help your primary antidepressant work more effectively, or it can be used to address specific symptoms like anxiety or insomnia.
• There are several strategies for addressing the cost of booster meds if your insurance doesn't offer coverage for the drug your provider wants to prescribe.