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 and bupropion-SR: combining versus switching in patients with treatment-resistant depression.
OBJECTIVE There are limited data comparing medication strategies in patients with treatment-resistant depression . In this study , we compared the effects of combining citalopram and bupropion-SR versus switching to the other monotherapy in treatment-resistant depression . METHOD This was a naturalistic , open-label cohort study . Patients with DSM-IV major depressive disorder who had not responded to at least 1 previous antidepressant and at least 6 weeks of treatment with citalopram or bupropion-SR were treated in a st and ard clinical protocol . In alternate months , eligible consecutive patients were treated by adding citalopram or bupropion-SR , or by switching to the other medication . Patients were assessed at baseline and after 6 weeks of treatment with the 29-item version of the  Structured Interview Guide for the Hamilton Depression Rating Scale , Seasonal Affective Disorders Version ( SIGH-SAD ) . RESULTS A total of 61 patients completed the study : 32 in the combination condition and 29 in the monotherapy switch condition . The combination condition was superior to the monotherapy switch in the SIGH-SAD change score ( -14.8 vs. -10.1 , respectively , p < .04 ) and the proportion of patients in clinical remission ( 28 % vs. 7 % , p < .05 ) . There were no differences in the proportion of patients who had side effects or in the severity of the side effects experienced . CONCLUSION The results of this cohort study suggest that combining citalopram and bupropion-SR is more effective than switching to a monotherapy . Combination treatment was well tolerated with no greater side effect burden than monotherapy . Limitations of this study include the nonr and omized design , open-label treatment , and small sample size
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 .