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 .
Switching versus augmentation: a prospective, naturalistic comparison in depressed, treatment-resistant patients.
OBJECTIVE ( 1 ) To directly compare the effectiveness of switching antidepressants with augmenting them in depressed patients who do not respond to an initial adequate trial and ( 2 ) to determine whether there is a decreased likelihood of response to a second switch or augmentation trial in those patients who did not respond to the first intervention for treatment-resistant depression . METHOD In a naturalistic , open-label design , all depressed out patients ( DSM-IV criteria ) who were treatment resistant were prospect ively assessed . Short- and long-term outcomes of switching versus augmentation were compared using the Clinical Global Impressions scale . RESULTS In the acute phase , 37 ( 50.0 % ) of 74 subjects responded to 1 of the 2 interventions for treatment-resistant depression . Forty-five percent ( N = 17 ) and 56 % ( N = 20 ) of the patients who had their antidepressant switched or augmented , respectively , responded to that intervention . Nearly three fourths ( 71.4 % ) of the acute responders maintained their response through 6 months of follow-up . In 18 patients who did not respond to the first switch or augmentation , 9 ( 50.0 % ) responded to a second trial . CONCLUSION Switching antidepressants was somewhat less effective than augmentation , although this difference was not statistically significant . For patients who do not respond to an augmentation or switch , our results suggest that a second trial for treatment-resistant depression may be as effective as the first
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 .