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 .
A double-blind, randomized study to provide safety information on switching fluoxetine-treated patients to paroxetine without an intervening washout period.
BACKGROUND The long elimination half-lives of fluoxetine and norfluoxetine , the active metabolite of fluoxetine , are of potential consequence when alternative antidepressant agents are introduced after the termination of fluoxetine therapy . It is not known whether paroxetine , an antidepressant agent in the same pharmacologic class as fluoxetine , can be substituted for fluoxetine without the need for an intervening washout period . The objective of this trial was to assess the tolerability of an immediate switch from fluoxetine to paroxetine therapy . METHOD Patients who were treated for moderate to moderately severe major depressive disorder ( DSM-III-R 296.2 or 296.3 ) with a stable dose of fluoxetine for a minimum of 6 weeks ' duration were r and omized in a double-blind fashion to one of two treatment groups . One group ( N = 123 ) was started on 20 mg of paroxetine daily the morning after their last dose of fluoxetine , and the other group ( N = 119 ) was started on 20 mg of paroxetine daily following a 2-week placebo-washout period . Patient visits were scheduled at weekly intervals for a total of 4 weeks . Adverse experience monitoring was conducted at each visit . RESULTS There was no difference in the proportion of patients who discontinued prematurely from the trial due to an adverse experience . Eight patients in the immediate-switch group and 6 patients in the placebo-washout group withdrew from the trial in response to an adverse experience ( p = .63 , chi-square ) . The overall profile of adverse experiences was similar in the two treatment groups over the 4-week period . The incidence of adverse experiences in the first 2 weeks following the initiation of paroxetine was generally lower in the group with the intervening 2-week placebo-washout period . CONCLUSION The immediate switch from fluoxetine to paroxetine was as well tolerated as the switch to paroxetine after a 2-week placebo-washout period
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 .