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 .
[The concept of resistant depression and therapeutic strategies, particularly, with venlafaxine].
About 30 % of depressed patients exhibit depression that is resistant to antidepressant treatment . This resistance may be primary or associated with a concomitant psychiatric or somatic disease . Venlafaxine has shown potent efficacy in certain severe depressions in in- patients and in patients presenting with resistant depression in an open-label study . It was considered of interest to compare , under double-blind , the efficacy of venlafaxine ( 200 to 300 mg/day ) and that of paroxetine ( 30 to 40 mg/day ) ( for 6 weeks ) in 123 patients presenting with major depression resistant to two correctly conducted antidepressant treatments in the course of an episode of depression of duration not exceeding 8 months . The patients were required not to present with organic disease , particularly endocrine disease . After 28 days of treatment , half of the patients receiving venlafaxine and one third of the patients receiving paroxetine showed a 50 % reduction in their total score on the Hamilton scale . In addition , the percentage of patients presenting with remission was significantly higher in the group receiving venlafaxine ( 42 % ) compared to that receiving paroxetine ( 20 % ) . These results require confirmation over the long term and in other forms of resistant 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 .