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 .
Bupropion in tricyclic antidepressant nonresponders with unipolar major depressive disorder.
Tricyclic antidepressant ( TCA ) medications are among the most widely used pharmacologic treatments for depression . However , a substantial number of patients fail to respond to these agents . Few st and ardized trials of pharmacologic treatments for TCA nonresponders are available . Bupropion has an apparently different mechanism of action than TCAs and represents a possible treatment for the TCA nonresponder . Based on positive results from pilot studies , a st and ardized study evaluating bupropion in TCA nonresponders was conducted . Forty-one depressed out patients who had failed to respond to adequate documented TCA treatment , defined by specific criteria of dosage , duration , and plasma concentrations , entered a 1-week single-blind placebo phase , followed by an open 8-week bupropion treatment phase utilizing doses of up to the maximum daily dose of 450 mg . Response was measured by change on the Hamilton Depression Rating Scale ( HAM-D ) , Clinical Global Impressions-Severity ( CGI-S ) and Improvement ( CGI-I ) Scales , and the Hamilton Anxiety Rating Scale ( HAM-A ) .  Bupropion treatment result ed in an improvement in depression on all outcome measures . Forty-nine percent were considered " responders , " in that they achieved > or = 50 % improvement on the 28-item HAM-D. Fifty-four percent were classified as responders based on a CGI-I rating of much or very much improved . Statistically significant improvement in depressive symptoms , measured by mean scores for the HAM-D , CGI-S , and HAM-A , was achieved at the end of the study ( as compared to baseline ) . Twelve patients ( 32 % ) had a HAM-D score of < or = 10 at termination . ( ABSTRACT TRUNCATED AT 250 WORDS
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 .