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 .
Treatment of imipramine-resistant recurrent depression, III: Efficacy of monoamine oxidase inhibitors.
BACKGROUND The effectiveness of monoamine oxidase inhibitors ( MAOIs ) in tricyclic resistant depression has received surprisingly little systematic study . METHOD Patients who failed to respond to sustained , adequate treatment with the tricyclic imipramine ( mean maximum dosage = 260 mg/day ) and interpersonal psychotherapy were withdrawn from imipramine and treated in a st and ardized , but open-label 6-week trial with either phenelzine ( N = 4 ; 60 mg/day ) or tranylcypromine ( N = 36 ; mean = 38.5 mg/day ) and continued interpersonal psychotherapy . RESULTS Forty of 42 patients ( 95 % ) completed the trial , of whom 23 ( 58 % ) responded to treatment . Highly significant improvement was documented on measures of depression , reversed neurovegetative symptoms , and somatic symptoms . Response was significantly correlated with severity of depression ( pre-MAOI score on the Hamilton Rating Scale for Depression ) , severity of a composite score of anergic and reversed neurovegetative features , and low levels of improvement during initial imipramine/interpersonal psychotherapy . Of patients who met criteria for proposed subforms of anergic or atypical depression , 67 % ( 18/27 ) responded ( p less than .05 ) ; 77 % ( 17/22 ) of patients who scored above the mean on the composite measure of anergic and reversed neurovegetative features responded ( p less than .01 ) . CONCLUSION These findings provide strong evidence of the utility of MAOIs in tricyclic-resistant depression , especially in patients with features such as fatigue , volitional inhibition , motoric retardation , hypersomnia , and /or weight gain
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 .