Several sources were searched for randomized clinical trials comparing these two switch strategies.ĭata from four clinical trials (n = 1496) were combined using a random-effects model. The goal of the present work was to conduct a meta-analysis of studies comparing these two switch strategies. Two broad treatment options exist for switching antidepressants for depressed patients who fail to respond to a selective serotonin reuptake inhibitor (SSRI): either a second course of SSRI therapy or a different class of antidepressants. In depressed nonresponders to a previous antidepressant treatment, switching to a different class of antidepressants was not associated with a better response or remission rate. There was no significant difference in response or remission rates between the across-class and within-class groups after controlling for possible confounders. Subjects whose current depressive episode had failed to respond to a first antidepressant trial of adequate dose and duration were included. Three hundred forty patients with primary major depressive disorder were recruited in the context of a European multicenter project. This retrospective study was undertaken to investigate whether there is a better response in nonresponders switched to a different class of antidepressants (across-class) compared with nonresponders switched to an antidepressant from the same class (within-class). In particular, the evidence supporting the commonly suggested sequential use of antidepressants from 2 different pharmacological classes is weak. The management of treatment-resistant depression is a much debated issue. Studies to identify the best multistep treatment sequences for individual patients and the development of more broadly effective treatments are needed. When more treatment steps are required, lower acute remission rates (especially in the third and fourth treatment steps) and higher relapse rates during the follow-up phase are to be expected. In addition, lower relapse rates were found among participants who were in remission at follow-up entry than for those who were not after the first three treatment steps. Overall, those who required more treatment steps had higher relapse rates during the naturalistic follow-up phase. The overall cumulative remission rate was 67%. The QIDS-SR(16) remission rates were 36.8%, 30.6%, 13.7%, and 13.0% for the first, second, third, and fourth acute treatment steps, respectively. ![]() A score of or=11 (HRSD(17)>or=14) defined relapse. Those with an acceptable benefit, preferably symptom remission, from any particular step could enter a 12-month naturalistic follow-up phase. Those not achieving remission with or unable to tolerate a treatment step were encouraged to move to the next step. This report describes the participants and compares the acute and longer-term treatment outcomes associated with each of four successive steps in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial.Ī broadly representative adult outpatient sample with nonpsychotic major depressive disorder received one (N=3,671) to four (N=123) successive acute treatment steps.
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