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 fluoxetine nonresponders.
BACKGROUND We assessed the tolerability and utility of switching fluoxetine nonresponders to citalopram the day that fluoxetine therapy was stopped . METHOD Fifty-eight out patients with DSM-IV major depressive episode and prospect ively confirmed nonresponse to fluoxetine ( mean final dose = 31 mg/day ) were switched directly to citalopram ( 20 mg/day ) . Of the 58 patients , 44 ( 76 % ) had never been successfully treated with antidepressant medication . During a 12-week open-label treatment period , citalopram could be titrated up to a maximum dose of 60 mg/day . Response was evaluated using the Clinical Global Impressions ( CGI ) scale , the 24-item Hamilton Rating Scale for Depression , and several other measures . RESULTS Eighty-one percent ( N = 47 ) completed the trial , and citalopram ( mean dose = 38.8 mg/day ) was well tolerated . The intent-to-treat CGI response rate was 46 % ( 26/57 ) at week 6 and 63 % ( 36/57 ) at study endpoint ; the completer response rate was 76 % among the 47 patients who completed the 12-week trial . Improvement from baseline on all dependent measures was statistically significant after the first week of citalopram treatment . CONCLUSION Fluoxetine nonresponders can be quickly switched to citalopram , with good tolerability and reasonable chance of therapeutic benefit . Further work is necessary to assess the merits of this treatment strategy relative to other options
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 .