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

Kudlow, Paul; McIntyre, Roger S.; Lam, Raymond W.

doi:10.1007/s40263-014-0171-5

Cited by 74 publications

(62 citation statements)

References 45 publications

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“…79 The lack of early improvement at 2 to 4 weeks is also a predictor of later antidepressant nonresponse/nonremission. However, there is only low-quality evidence to support early switching at 2 or 4 weeks for nonimprovers to an initial antidepressant.…”

Section: How Long Do You Wait For a Response From An Antidepressant?mentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder

et al. 2016

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Background: The Canadian Network for Mood and Anxiety Treatments (CANMAT) conducted a revision of the 2009 guidelines by updating the evidence and recommendations. The scope of the 2016 guidelines remains the management of major depressive disorder (MDD) in adults, with a target audience of psychiatrists and other mental health professionals. Methods: Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. ''Pharmacological Treatments'' is the third of six sections of the 2016 guidelines. With little new information on older medications, treatment recommendations focus on second-generation antidepressants.Results: Evidence-informed responses are given for 21 questions under 4 broad categories: 1) principles of pharmacological management, including individualized assessment of patient and medication factors for antidepressant selection, regular and

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Section: How Long Do You Wait For a Response From An Antidepressant?mentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder

et al. 2016

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“…These results support a measurement-based care approach that includes monitoring of function at baseline and during therapy in order to rapidly optimize treatment for the best chance of restoring the patient to pre-illness function. 48 Limiting the length of a trial of an ineffective treatment reduces the burden of illness on the patient and may improve long-term function. 7,8…”

Section: Discussionmentioning

confidence: 99%

Predictors of functional response and remission with desvenlafaxine 50 mg and 100 mg: a pooled analysis of randomized, placebo-controlled studies in patients with major depressive disorder

2019

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Objective.The value of early functional improvement at week 2 for predicting subsequent functional outcomes at week 8 was assessed in a pooled analysis of patients with major depressive disorder (MDD) treated with desvenlafaxine (50 or 100 mg/d) or placebo.Methods.Data were pooled from eight double-blind, placebo-controlled studies of desvenlafaxine 50 mg/d or 100 mg/d for the treatment of MDD. Optimal week-2 improvement thresholds in Sheehan Disability Scale (SDS) score, which best predicted week-8 treatment success, were determined using receiver operating characteristic (ROC) analysis. Four definitions of treatment success were established: (1) functional response, (2) functional/depression response, (3) functional remission, and (4) functional/depression remission. Odds ratios (ORs) of early improvement for prediction (based on thresholds determined in the ROC analysis) of week-8 treatment success were computed using logistic regression models.Results.Functional early improvement thresholds of 17%–32% were predictive of week-8 treatment success across treatment groups and definitions of treatment success. Optimal thresholds were higher for more stringent definitions. Negative predictive value exceeded positive predictive value, indicating that failure to achieve early functional improvement was more informative about later treatment success than was the achievement of early functional improvement. Early change in SDS was a highly significant predictor of functional response/remission (ORs, 4.981–8.737; all p < 0.0001); the interaction between treatment and early functional improvement was not significant.Conclusion.Early improvement in SDS total score was predictive of functional outcomes for patients treated with desvenlafaxine 50 mg, desvenlafaxine 100 mg, or placebo.

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“…This supports the importance of keeping the patients on an antidepressant treatment for an appropriate amount of time before changing it. On the other hand, multiple studies show that if patients have less than 25% reduction of symptoms after 4 weeks treatment, it could be indicated to switch to a different treatment strategy [54].…”

Section: Optimizationmentioning

confidence: 99%

Resistant Depression

Alfonso Ontiveros

2019

Antidepressants - Preclinical, Clinical and Translational Aspects

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The term resistant points out a clinical phenomenon in which there is a lack of response to one or more therapeutic interventions. Resistance to major depressive disorder treatment causes distress to patients and their relatives, and increases the number of hospital admissions, outpatient consultations, use of psychoactive drugs, and treatment costs. Despite its serious medical and psychosocial medical implications, the definition of treatment resistant depression continues to be ambiguous and controversial. The lack of an agreement on definition, as well as the research on the subject being difficult, limits the practical knowledge on the best treatment options for groups of treatment resistant depression (TRD) patients. We review the concept and definitions of treatment resistant depression as well as the medical literature on different treatment methods studied and comparative studies. Finally, some relevant neurobiological data are reviewed.

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

Cited by 74 publications

References 45 publications

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder

Predictors of functional response and remission with desvenlafaxine 50 mg and 100 mg: a pooled analysis of randomized, placebo-controlled studies in patients with major depressive disorder

Resistant Depression

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