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 .
Are patients who are intolerant to one serotonin selective reuptake inhibitor intolerant to another?
BACKGROUND The question was asked whether patients who discontinue one serotonin selective reuptake inhibitor ( SSRI ) because of side effects can be treated successfully with another SSRI . METHOD 113 patients with major depression who had discontinued fluoxetine because of side effects were enrolled in an open , multicenter , 8-week study design ed to evaluate the tolerability and efficacy of sertraline . After a washout period of at least 3 weeks following fluoxetine discontinuation and an additional 1-week , single-blind , placebo washout period , patients began treatment with 50 mg of sertraline once daily . Doses were titrated upward as necessary to a maximum daily dose of 200 mg . Depressive symptoms and adverse events were evaluated weekly . RESULTS Based on the Clinical Global Impressions Scale , 79 ( 71.8 % ) of 110 patients evaluated for efficacy were " much " or " very much " improved relative to baseline . Only 11 ( 9.8 % ) of 112 patients discontinued sertraline because of adverse reactions . CONCLUSION These results suggest that patients who discontinue one SSRI because of side effects can be treated successfully with another
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 .