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 .
Citalopram treatment of paroxetine-intolerant depressed patients.
We assessed the tolerability and antidepressant response to citalopram in a group of patients who could not tolerate a recent trial of paroxetine therapy . Sixty-one out patients with major depressive disorder and a confirmed history of intolerance to paroxetine ( mean final dose : 26.7 mg/day ) were switched after at least a 1 week washout to citalopram therapy ( 20 mg/day ) . During the 6-week , open label treatment protocol , citalopram could be titrated up to a maximum dose of 40 mg/day . Response was evaluated using the Clinical Global Impressions CGI scale , the 24-item Hamilton Rating Scale for Depression , and several other measures of symptoms and quality of life . Fifty-three patients ( 87 % ) completed 6 weeks of citalopram therapy ( mean intent-to-treat dose : 23.9 mg/day ) . The specific side effects that were reported to be intolerable during the earlier paroxetine trial typically recurred only less than 30 % of the time during citalopram therapy ; only 6 patients ( 10 % ) dropped out because of adverse events . The intent-to-treat CGI response rate was 56 % at study endpoint ; 62 % of the completers responded . Significant improvement from pretreatment was observed on various symptom measures after two weeks of citalopram therapy . Citalopram therapy was well tolerated , and more than one half of the patients who began treatment improved significantly . Although further work is necessary to assess the relative merits of this within-class switching strategy ( as compared to other options ) , these data provide further evidence that the various selective serotonin reuptake inhibitors do not have interchangeable tolerability profiles
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 .