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 .
Nefazodone therapy in patients with treatment-resistant or treatment-intolerant depression and high psychiatric comorbidity.
Given the potentially severe functional impairment , morbidity , and high costs associated with refractory depression , it is important to explore all treatment options that may benefit patients with this disorder . This is a retrospective , uncontrolled analysis of our experience with nefazodone therapy in treatment-resistant and treatment-intolerant depression . Potential c and i date s for nefazodone therapy were referred by their treating psychiatrist . Documentation of failure to respond to previous antidepressant therapy , a diagnosis of clinical depression according to criteria in the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , and completion of a Beck Depression Inventory ( BDI ) were required before initiation of nefazodone . A follow-up BDI was obtained after > or = 4 weeks of nefazodone therapy . A Clinical Global Inventory ( CGI ) score was obtained retrospectively based on documentation of target symptoms in the clinical record of the last clinic visit . The study group consisted of 20 patients with treatment-resistant or treatment-intolerant major depression who received nefazodone therapy . The mean ( + /- SD ) age of the group was 48.1+/-9.4 years . The mean number of previously failed antidepressant trials was 1.9+/-0.6 . Psychiatric comorbidity in this group was substantial , with posttraumatic stress disorder ( PTSD ) found in 11 ( 55 % ) patients , substance abuse in 3 ( 15 % ) patients , and personality disorder found in 2 ( 10 % ) patients . After treatment with nefazodone , 11 of 20 patients ( 55 % ) were rated on the CGI as much or very much improved . In addition , 9 patients ( 45 % ) had > 20 % improvement on BDI , 3 patients ( 15 % ) had 10 % to 20 % improvement , and 6 patients ( 30 % ) had < 10 % change . Two patients ( 10 % ) discontinued nefazodone therapy due to adverse effects . Analysis of our experience with nefazodone therapy in a population with treatment-resistant depression and a high degree of psychiatric comorbidity suggests that approximately 50 % of patients may have substantial response to treatment , with a smaller proportion having a more modest clinical response . While receiving nefazodone therapy , most patients continued to take concurrently prescribed psychotropic medications , primarily anxiolytics or other antidepressants . Of interest was the positive drug response among a subgroup of individuals with depression and chronic , severe PTSD . Larger , controlled studies are needed to determine whether these preliminary observations are confirmed
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 .