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 .
Time to recovery, chronicity, and levels of psychopathology in major depression. A 5-year prospective follow-up of 431 subjects.
The course of illness of 431 subjects with major depression participating in the National Institute of Mental Health Collaborative Depression Study was prospect ively observed for 5 years . Twelve percent of the subjects still had not recovered by 5 years . There were decreasing rates of recovery over time . For example , 50 % of the subjects recovered within the first 6 months , and then the rate of recovery declined markedly . Instantaneous probabilities of recovery reflect that the longer a patient was ill , the lower his or her chances were of recovering . For patients still depressed , the likelihood of recovery within the next month declined from 15 % during the first 3 months of follow-up to 1 % to 2 % per month during years 3 , 4 , and 5 of this follow-up . The severity of current psychopathology predicted the probability of subsequent recovery . Subjects with moderately severe depressive symptoms , minor depression , or dysthymia had an 18-fold greater likelihood of beginning recovery within the next week than did subjects who were at full criteria for major depressive disorder . Many subjects who did not recover continued in an episode that looked more like dysthymia than major depressive disorder
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 .