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 strategy in depression
Antidepressants are ineffective in about 30 % of patients with major depression . Some authors then advise treatment of non‐responders with ( non‐tricyclic ) more selective reuptake inhibitors . In a double‐blind , partial crossover study , 71 patients were selected for treatment during 4 weeks with oxaprotiline and /or fluvoxamine , two non‐tricyclic antidepressants that are selective reuptake inhibitors of noradrenaline and serotonin respectively . All patients had failed to respond to earlier treatment with cyclic antidepressants during the current episode . Only 13 % of the patients responded , with 27 % of them responding to oxaprotiline and none to fluvoxamine . Moreover , a low response of 27 % was also obtained in the crossover phase , which included all non‐responders to the first treatment , oxaprotiline being effective in 39 % and fluvoxamine in 10 % of the patients . The results indicate that selective reuptake inhibitors are not an effective alternative for non‐responders to other cyclic antidepressants and that non‐responders to “ nor‐adrenergic ” antidepressants do not appear to have much chance of responding to “ serotonergic ” antidepressants and vice versa
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 .