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 .
Nortriptyline for treatment-resistant depression.
BACKGROUND Up to 30 % of patients with major depression fail to respond to an antidepressant trial , with most taking a selective serotonin reuptake inhibitor ( SSRI ) as initial treatment . While the tricyclic antidepressants might be effective for SSRI nonresponders , they have been relegated to third- and fourth-line treatment . This study assesses the efficacy of nortriptyline for patients with treatment-resistant major depression . METHOD 92 patients with treatment-resistant DSM-III-R major depression , with resistance defined by at least 1 , but no more than 5 , well-documented adequate trials of antidepressants during the current episode , were treated openly with nortriptyline for 6 weeks . Patients were titrated up to full target doses of nortriptyline within 1 week , with target blood levels of 100 ng/mL. Response was defined as a 50 % or greater decrease of baseline 17-item Hamilton Rating Scale for Depression score . We performed an intent-to-treat analysis with the last observation carried forward . RESULTS Approximately 40 % of patients were responders ( N = 39 ) and 12 % were remitters ( N = 11 ) after 6 weeks of nortriptyline . Over a third of patients were unable to complete the trial . CONCLUSION Nortriptyline was effective for over a third of patients with treatment-resistant depression , and nortriptyline should be considered as potential treatment if patients fail to respond to other antidepressants
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 .