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 .
Double-blind switch study of imipramine or sertraline treatment of antidepressant-resistant chronic depression.
BACKGROUND Although various strategies have been proposed to treat antidepressant nonresponders , little controlled research has been published that examines prospect ively the use of switching to an alternate antidepressant . METHODS This was a multisite study in which out patients with chronic major depression ( with or without concurrent dysthymia ) , who failed to respond to 12 weeks of double-blind treatment with either sertraline hydrochloride ( n = 117 ) or imipramine hydrochloride ( n = 51 ) , were crossed over or switched to 12 additional weeks of double-blind treatment with the alternate medication . Outcome measures included the 24-item Hamilton Rating Scale for Depression and the Clinical Global Impressions -- Severity and Improvement scales . RESULTS The switch from sertraline to imipramine ( mean dosage , 221 mg/d ) and from imipramine to sertraline ( mean dosage , 163 mg/d ) result ed in clinical ly and statistically significant improvements . The switch to sertraline treatment was associated with fewer adverse effect complaints and significantly less attrition owing to adverse effects . Although sertraline treatment also result ed in significantly higher response rates in the intent-to-treat sample s ( 60 % in the sertraline group and 44 % in the imipramine group ) , neither the intent-to-treat remission rates nor the response and remission rates among study completers differed significantly . Moreover , after considering the effect of attrition , there were no significant treatment effects on the more comprehensive generalized estimating equation analyses of the continuous dependent measures . CONCLUSIONS More than 50 % of chronically depressed antidepressant nonresponders benefited from a switch from imipramine to sertraline , or vice versa , despite a high degree of chronicity . As in the initial trial , sertraline was generally better tolerated than imipramine . Switching to a st and ard antidepressant of a different class is a useful treatment strategy for antidepressant nonresponders and could be considered a st and ard of comparison for future studies of novel alternate strategies
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 .