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 .
Tranylcypromine versus venlafaxine plus mirtazapine following three failed antidepressant medication trials for depression: a STAR*D report.
OBJECTIVE The purpose of this study was to compare the effectiveness and tolerability of tranylcypromine and combination treatment with extended-release venlafaxine and mirtazapine in patients with treatment-resistant major depression whose current depressive episode had not responded adequately to treatment in three prior prospect i ve medication trials . METHOD Adult out patients with nonpsychotic major depressive disorder who had not achieved remission or had withdrawn from treatment because of intolerance in three previous prospect i ve medication trials were r and omly assigned to receive open-label treatment with either tranylcypromine ( N=58 ) or extended-release venlafaxine plus mirtazapine ( N=51 ) . The primary outcome measure was whether patients achieved remission , which was defined as a score < or = 7 at exit on the 17-item Hamilton Depression Rating Scale ( HAM-D ) . The HAM-D was administered by telephone by raters to whom treatment was masked . RESULTS Remission rates were not significantly different between the two treatment groups ( 6.9 % for the tranylcypromine group and 13.7 % for the venlafaxine plus mirtazapine group ) . The mean daily dose at exit for tranylcypromine was 36.9 mg ( SD=18.5 ) ; for venlafaxine , 210.3 mg ( SD=95.2 ) ; and for mirtazapine , 35.7 mg ( SD=17.6 ) . Tranylcypromine was associated with significantly less symptom reduction and greater attrition due to intolerance . CONCLUSIONS Remission rates were modest for both the tranylcypromine group and the extended-release venlafaxine plus mirtazapine group , and the rates were not statistically different between groups . The lower side effect burden , lack of dietary restrictions , and ease of use of venlafaxine and mirtazapine suggest that this combination may be preferred over tranylcypromine for patients with highly treatment-resistant depression who have not benefited adequately from several prior treatments
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 .