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 .
Venlafaxine in treatment-resistant major depression: a Canadian multicenter, open-label trial.
This was an 8-week , multicenter , open-label study of the efficacy and tolerability of venlafaxine in patients with treatment-resistant depression conducted in Canada . In patients or out patients aged 18 to 70 years with major depression were eligible if they had a 21-item Hamilton Rating Scale for Depression ( HAM-D-21 ) score of 2 > or = 18 and a documented history of unsatisfactory improvement after a minimum of 8 weeks of treatment with an adequate dose of an antidepressant . Treatment with venlafaxine was started at 37.5 mg twice daily , and the dose could be titrated upward to a maximum of 375 mg/day during the first 4 weeks on the basis of the investigator 's assessment of clinical response and tolerability . Of the 159 patients enrolled , 152 were evaluable for efficacy . The mean daily venlafaxine dose was 260 mg/day . The mean HAM-D-21 score decreased by 52 % , and the mean Montgomery-Asberg Depression Rating Scale score decreased by 50 % from baseline to day 56 . A response ( 50 % improvement from baseline ) was achieved by 58 % of patients on the HAM-D-21 , and a remission ( > or = 75 % improvement in the HAM-D-21 ) was observed in 28 % at day 56 . By day 56 , 88 % of patients had improved from baseline on the Clinical Global Impression Improvement scale . Only 8 % of the patients discontinued for adverse events . The most common adverse events were headache , insomnia , nausea , constipation , diaphoresis , and xerostomia . In conclusion , these results suggest that venlafaxine is effective and well tolerated for the management of patients with treatment-resistant major depression
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 .