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 .
Clinical results for patients with major depressive disorder in the Texas Medication Algorithm Project.
CONTEXT The Texas Medication Algorithm Project is an evaluation of an algorithm-based disease management program for the treatment of the self-declared persistently and seriously mentally ill in the public mental health sector . OBJECTIVE To present clinical outcomes for patients with major depressive disorder ( MDD ) during 12-month algorithm-guided treatment ( ALGO ) compared with treatment as usual ( TAU ) . DESIGN Effectiveness , intent-to-treat , prospect i ve trial comparing patient outcomes in clinics offering ALGO with matched clinics offering TAU . SETTING Four ALGO clinics , 6 TAU clinics , and 4 clinics that offer TAU to patients with MDD but provide ALGO for schizophrenia or bipolar disorder . Patients Male and female out patients with a clinical diagnosis of MDD ( psychotic or nonpsychotic ) were divided into  ALGO and TAU groups . The ALGO group included patients who required an antidepressant medication change or were starting antidepressant therapy .  The TAU group initially met the same criteria , but because medication changes were made less frequently in the TAU group , patients were also recruited if their Brief Psychiatric Rating Scale total score was higher than the median for that clinic 's routine quarterly evaluation of each patient . MAIN OUTCOME MEASURES Primary outcomes included ( 1 ) symptoms measured by the 30-item Inventory of Depressive Symptomatology-Clinician-Rated scale ( IDS-C(30 ) ) and ( 2 ) function measured by the Mental Health Summary score of the Medical Outcomes Study 12-item Short-Form Health Survey ( SF-12 ) obtained every 3 months . A secondary outcome was the 30-item Inventory of Depressive Symptomatology-Self-Report scale ( IDS-SR(30 ) ) . RESULTS All patients improved during the study ( P<.001 ) , but ALGO patients had significantly greater symptom reduction on both the IDS-C(30 ) and IDS-SR(30 ) compared with TAU . ALGO was also associated with significantly greater improvement in the SF-12 mental health score ( P = .046 ) than TAU . CONCLUSION The ALGO intervention package during 1 year was superior to TAU for patients with MDD based on clinician-rated and self-reported symptoms and overall mental functioning
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 .