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 .
Pharmacological choices after one antidepressant fails: a survey of UK psychiatrists.
BACKGROUND At least 30 % of depressed patients fail to respond to adequate first-line anti-depressant medication . Several pharmacological strategies have been suggested to treat such refractory depression . There has been no survey of United Kingdom psychiatrists ' treatment preferences for refractory depression . This study was carried out to determine both experience and preference of various strategies for management of refractory depression . METHOD A total of 300 fellows , members and inceptors of the Royal College of Psychiatrists were r and omly selected and approached by postal question naire . They were asked to comment on management of a detailed clinical vignette of a case of depression with initial treatment failure . RESULTS The response rate was 63 % ( n = 175 ) . The most popular treatment choices were increasing dosage of tricyclic medication and change of medication of SSRI . The most rarely selected were augmentation with triiodothyronine ( T3 ) and augmentation with tryptophan or MAOIs .  Treatment choice was significantly influenced by previous experience . A large number ( 39 % ) of psychiatrists were not confident in treating refractory depression . CONCLUSION Surprisingly few psychiatrists chose to use the best proven pharmacological treatments such as augmentation with lithium or T3 . In view of this and the considerable proportion of psychiatrists lacking confidence in the management of refractory depression , this topic deserves priority as a topic for continuing professional development ( CPD ) courses
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 .