BACKGROUND: Two broad treatment options exist for switching antidepressants for @entity308 @entity1 who fail to respond to a selective @entity750 reuptake inhibitor (SSRI): either a second course of SSRI therapy or a different class of antidepressants. The goal of the present work was to conduct a meta-analysis of studies comparing these two switch strategies. METHODS: Several sources were searched for randomized clinical trials comparing these two switch strategies. RESULTS: Data from four clinical trials (n = 1496) were combined using a random-effects model. @entity1 randomized to switch to a non-SSRI antidepressant ( @entity752 , @entity13332 , @entity906 ) were more likely to experience remission than @entity1 switched to a second SSRI (risk ratio = 1.29, p = .007). Pooled remission rates were 28% (for non-SSRIs) and 23.5% (for SSRIs). There was also a nonsignificant trend (p = .1) in the rate of discontinuation due to intolerance favoring the within-class switch strategy (risk ratio = 1.23). There was no difference in response rates between the two treatment groups. CONCLUSIONS: These results suggest a modest yet statistically significant advantage in remission rates when switching @entity1 with SSRI-resistant @entity308 to a non-SSRI rather than an SSRI antidepressant. With the number needed to treat (NNT) statistic as one indicator of clinical significance, nearly 22 SSRI nonresponders would need to be switched to a non-SSRI rather than a second SSRI antidepressant to obtain one additional remitter. This difference falls well below the mark of NNT = 10 suggested by the United Kingdom's National Institute of Clinical Excellence but nonetheless might be of public health relevance given the large number of SSRI-resistant @entity1 switched to an SSRI versus a non-SSRI antidepressant.

Treatment of SSRI-resistant XXXX : a meta-analysis comparing within- versus across-class switches.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients'] @entity308 :: ('MESH:D003866', 'Disease') :: ['depressed', 'depression'] @entity13332 :: ('MESH:C035133', 'Chemical') :: ['mirtazapine'] @entity750 :: ('MESH:D012701', 'Chemical') :: ['serotonin'] @entity906 :: ('MESH:C047426', 'Chemical') :: ['venlafaxine'] @entity752 :: ('MESH:D016642', 'Chemical') :: ['bupropion']
@entity308 :: (MESH:D003866,Disease) :: ['depression']
