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 .
Consensus guidelines in the treatment of major depressive disorder.
The number of available antidepressant medications has increased dramatically in the last 10 years . Furthermore , no single medication is a panacea for all depressed patients -a fact underscored by r and omized , controlled trial evidence showing that when one medication fails , an alternative may succeed . Thus , a key issue in the treatment of depression is how to optimally orchestrate available medication options to maximally benefit the greatest number of patients most rapidly . One approach is the use of consensus guidelines or medication algorithms . This paper discusses the rationale for and critical issues in the development of medication algorithms , and the timely use of symptom measures to ensure proper implementation . Once developed , guidelines must be appropriately implemented by clinicians , adhered to by patients , and supported by administrators . These three stakeholder groups often need education , incentives , and ongoing support to implement such guidelines . Whether guidelines actually improve outcome is largely uninvestigated , although a recent study of depressed patients in primary care found that using guidelines did improve outcome but at an increased treatment cost . The clinical and economic impact of guideline -driven treatment for the severe and persistently depressed deserves study
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 .