Is switching antidepressants following early nonresponse more beneficial in acute-phase treatment of depression?: A randomized open-label trial

• Published in: Progress in neuro-psychopharmacology & biological psychiatry Vol. 35; no. 8; pp. 1983 - 1989
• Main Authors: Nakajima, Shinichiro, Uchida, Hiroyuki, Suzuki, Takefumi, Watanabe, Koichiro, Hirano, Jinichi, Yagihashi, Tatsuhiko, Takeuchi, Hiroyoshi, Abe, Takayuki, Kashima, Haruo, Mimura, Masaru
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Inc 01.12.2011; Elsevier
• Subjects: Adult; Adult and adolescent clinical studies; Aged; Antidepressant; Antidepressive Agents - therapeutic use; Biological and medical sciences; Citalopram - therapeutic use; Depression; Depressive Disorder, Major - drug therapy; Drug Substitution; Female; Humans; Major depressive disorder; Male; Medical sciences; Middle Aged; Mood disorders; Neuropharmacology; Onset; Paroxetine - therapeutic use; Pharmacology. Drug treatments; Predictor; Prospective Studies; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Sertraline - therapeutic use; Switching; Time Factors; Treatment Outcome; PAR; Antidepressant; SER; DSM-IV; SSRIs; Predictor; MADRS; MDD; Major depressive disorder; Switching; Onset; QEEG; CGI-S; CYP; MMRM; Mood disorder; Psychotropic; Acute; Depression; Drug conversion; Randomization; Treatment; Antidepressant agent; Early; Predictive factor
• ISSN: 0278-5846; 1878-4216; 1878-4216
• DOI: 10.1016/j.pnpbp.2011.08.008

Treatment guidelines for major depressive disorder (MDD) recommend a continuous use of antidepressants for several weeks, while recent meta-analyses indicate that antidepressant efficacy starts to appear within 2weeks and early treatment nonresponse is a predictor of subsequent nonresponse. We prospectively compared 8-week outcomes between switching antidepressants and maintaining the same antidepressant in early nonresponders, to generate a hypothesis on possible benefits of early switching strategy. Patients with MDD without any treatment history for the current episode were included. When subjects failed to show an early response (i.e., ≥20% improvement in the Montgomery–Åsberg Depression Rating Scale (MADRS)) to the initial treatment with sertraline 50mg at week 2, they were randomly divided into two groups; in the Continuing group, sertraline was titrated at 50–100mg, whereas sertraline was switched to paroxetine 20–40mg in the Switching group. A primary outcome measure was a response rate (i.e., ≥50% improvement in the MADRS) at week 8. Among 132 subjects, 41 subjects showed early nonresponse. The Switching group (n=20) showed a higher rate of responders than the Continuing group (n=21) (75% vs. 19%: p=0.002). Further, the Switching group was also superior in the rate of remitters (total score of ≤10 in the MADRS) (60% vs. 14%: p=0.004) and continuous changes in the MADRS (19.0 vs. 7.5: p<0.001). Our preliminary findings suggest that patients with MDD who fail to show early response to an initial antidepressant may derive benefits from the early switching antidepressants in the acute-phase treatment of depression. ► Antidepressant efficacy starts to appear within 2 weeks. ► Early treatment nonresponse is a predictor of subsequent nonresponse. ► We compare switching and continuing in early nonresponders with depression. ► Switching group shows a higher rate of responders and remitters at Week 8.► Early antidepressant switching may be more beneficial in acute-phase treatment.