Early switch strategy in patients with major depressive disorder

Abstract

Major depressive disorder is a highly prevalent and chronic mental disorder. There have been a number of antidepressants with different class employing different pharmacological profiles for treatment of major depressive disorder; however, currently available placebo-controlled or large practical clinical trials demonstrated that the efficacy of antidepressants is quite limited to yield full recovery for such patients. Approximately 30% of major depressive disorder patients remit with initial antidepressant treatment, whereas a chance of recurrence significantly increases with subsequent treatment failures. Hence, most treatment guidelines propose various treatment approaches such as augmentation, combination and switching strategies for such patients with initial treatment failure. Among these treatment approaches, switching strategies are widely used in clinical practice. However, controlled clinical trials of the proper timing of antidepressant switch have not been adequately evaluated yet. The authors of the article under evaluation have investigated whether an early switch strategy should result in shorter times to response and remission in patients with initial treatment failure. They found that a higher remission rate was seen with the early switch strategy than conventional switch strategies. This article will discuss the clinical significance, related practical issues, potential limitations and future research implications based on findings from the original study.

Early Switching Strategies in Antidepressant Non-Responders: Current Evidence and Future Research Directions

“…While the evidence has shown that antidepressants are an effective treatment for moderate to severe MDD [3], naturalistic studies indicate that up to two-thirds of patients do not respond to the first antidepressant medication [4], with the chance of response decreasing and recurrence significantly increasing with subsequent treatment failures [5]. Most clinical guidelines recommend switching to another antidepressant as a first-line strategy for non-responders, although augmentation and combination strategies also have evidence to support their use.…”

Early Symptom Improvement as a Predictor of Response to Extended Release Quetiapine in Major Depressive Disorder

“…Despite multiple options for treating major depressive disorder (MDD), response rates following initial antidepressant treatment vary, and estimates suggest that around two-thirds of patients will not achieve full symptomatic remission with an initial agent. 1 , 2 Common strategies used to improve efficacy in patients who have not responded to initial antidepressant therapy include switching to another antidepressant (usually a different class) and augmentation with a nonantidepressant. 3 Early identification of unresponsive patients can reduce the burden of MDD on patients/family and limit healthcare resource use.…”

Optimizing the Use of Aripiprazole Augmentation in the Treatment of Major Depressive Disorder: From Clinical Trials to Clinical Practice

“… 27 Anecdotal data support the usefulness of switching or combining antidepressant strategies; however, few clinical trials of such therapies have been conducted and the results are inconsistent. 18 28 29 30 31 32 A number of small RCTs have investigated the efficacy of switching therapy for depression (10 RCTs and 30 open-label studies). 27 33 34 35 According to these controlled clinical trials, the remission rates after switching therapy ranged from 10% to 80%.…”