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 .
Efficacy and tolerability of tranylcypromine versus phenelzine: a double-blind study in antidepressant-refractory depressed inpatients.
BACKGROUND The aim of this study was to examine whether phenelzine is a suitable alternative to tranylcypromine in antidepressant-resistant depression . METHOD A total of 77 severely depressed in- patients , meeting the DSM-IV criteria for major depressive disorder , who failed to respond to fixed plasma level treatment with either tricyclic antidepressants or fluvoxamine were withdrawn from psychotropic medication  and included in a double-blind flexible-dose 5-week comparison of tranylcypromine and phenelzine . RESULTS Of the 77 patients , 67 ( 87 % ) completed the trial , of whom 35 ( 52 % ) responded . No significant differences in response between both drugs were observed . Seventeen ( 44 % ) of 39 patients responded to tranylcypromine and 18 ( 47 % ) of 38 to phenelzine ( > or = 50 % reduction in Hamilton Rating Scale for Depression [ HAM-D ] score ) . The mean reduction in HAM-D score was 10.4 + /- 8.3 for the tranylcypromine sample versus 8.3 + /- 8.4 for the phenelzine-treated patients . Only a few patients ( 10 % ) used concomitant psychotropic medication . A substantial number of patients experienced severe side effects , mainly dizziness , agitation , and insomnia ; the incidence was the same in both sample s ( 21 % ) . CONCLUSION No difference in efficacy was observed between both monoamine oxidase inhibitors in a sample of patients with severe antidepressant-refractory depression . Phenelzine appears to be a suitable alternative to tranylcypromine
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 .