The number of previous treatments with antidepressants was negatively correlated with treatment outcome .
After a first SSRI , any switch within or between classes of antidepressants appears legitimate ( second SSRI , novel dual-acting antidepressants , selective norepinephrine or nor-adrenergic/dopaminergic agents , or tricyclic anti-depressant or mianserin ) .
No unequivocal evidence is available to prove an advantage of a between-class switch .
OBJECTIVE Selective serotonin reuptake inhibitors ( SSRIs ) are frequently used as a first antidepressant for major depressive disorder but have response rates of 50 % to 60 % in daily practice .
For patients with insufficient response to SSRIs , switching is often applied .
This article aims to systematic ally review the evidence for switching pharmacotherapy after a first SSRI .
Switching to Reboxetine: An Efficacy and Safety Study in Patients With Major Depressive Disorder Unresponsive to Fluoxetine
The aim of the present study was to evaluate the efficacy and safety of an immediate switch to reboxetine , a selective noradrenaline reuptake inhibitor ( selective NRI ) , in patients with depression unresponsive to the selective serotonin reuptake inhibitor ( SSRI ) fluoxetine . The study included 128 adult out patients with DSM-IV major depressive disorder ( MDD ) who had not responded to at least 6 to 12 weeks of fluoxetine treatment , with at least 3 weeks of treatment on a minimum dose of 40 mg/d . Patients were switched , without a washout period , to reboxetine 4 mg twice daily , with the possibility of increasing the dose to 10 mg/d ( given in divided doses ) after 4 weeks of treatment . Efficacy was assessed using the 17-item Hamilton Rating Scale for Depression ( HAM-D-17 ) and the Clinical Global Impression Improvement ( CGI-I ) and Severity ( CGI-S ) scales . Safety was evaluated by recording spontaneously reported adverse events . A statistically significant ( P < 0.001 ) improvement in the mean total HAM-D-17 score was seen from baseline by week 1 of treatment with reboxetine , and the improvement continue to week 8 . CGI-I and CGI-S scores were similarly improved . The switch to reboxetine was well tolerated ; the most common treatment-emergent adverse events were insomnia , headache , dry mouth , diaphoresis , and constipation , all of which were mild to moderate in severity and decreased in frequency as the study progressed . Immediate switching to reboxetine appears to be a safe and effective treatment for patients with depression who have failed to respond to an adequate dose of fluoxetine
The number of previous treatments with antidepressants was negatively correlated with treatment outcome .
After a first SSRI , any switch within or between classes of antidepressants appears legitimate ( second SSRI , novel dual-acting antidepressants , selective norepinephrine or nor-adrenergic/dopaminergic agents , or tricyclic anti-depressant or mianserin ) .
No unequivocal evidence is available to prove an advantage of a between-class switch .
OBJECTIVE Selective serotonin reuptake inhibitors ( SSRIs ) are frequently used as a first antidepressant for major depressive disorder but have response rates of 50 % to 60 % in daily practice .
For patients with insufficient response to SSRIs , switching is often applied .
This article aims to systematic ally review the evidence for switching pharmacotherapy after a first SSRI .