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

Nakajima, Shinichiro; Uchida, Hiroyuki; Suzuki, Takefumi; Watanabe, Koichiro; Hirano, Jinichi; Yagihashi, Tatsuhiko; Takeuchi, Hiroyoshi; Abe, Takayuki; Kashima, Haruo; Mimura, Masaru

doi:10.1016/j.pnpbp.2011.08.008

Cited by 38 publications

(31 citation statements)

References 46 publications

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“…Moreover, time to achieving normal functioning (Sheehan Disability Scale total score B6 [27]) was shorter in the early-switching group (p = 0.042) [26]. In summary, a small study found that an early switch (at 2 weeks) from sertraline to paroxetine led to superior outcomes compared with continuing on sertraline [23]. In contrast, both larger studies had negative results for primary outcomes for an early switch; only on analysis of secondary outcomes did some benefits of different strategies become apparent.…”

Section: Controlled Studies Of Early-switch Strategiesmentioning

confidence: 88%

“…Nakajima et al [23] completed a small sample (n = 41), randomized, openlabel trial that showed benefits of an early-switch strategy versus maintaining the same antidepressant in individuals who did not show early improvement. Patients (n = 132) were initially treated with sertraline 50 mg; non-improvers (\20 % reduction in MADRS) at 2 weeks were randomized to 6 weeks in one of two groups: (a) sertraline was continued and titrated at 50-100 mg (n = 21); (b) sertraline was switched to paroxetine 20-40 mg (n = 20).…”

Section: Controlled Studies Of Early-switch Strategiesmentioning

confidence: 99%

“…Lack of early improvement, and the randomization to switch, was defined as \20 % reduction in MADRS at 2 weeks [23], \50 % reduction on the MADRS at 2 weeks [24], and \30 % improvement on the HAM-D at 4 weeks [25]. One study switched from one SSRI to another [23], while the other two involved SSRI to SNRI switches. The question of whether a switch within an antidepressant class is superior to switching to another class is still in doubt.…”

Section: Limitations Of the Evidencementioning

confidence: 99%

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

2014

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Studies have found that up to two-thirds of patients with major depressive disorder (MDD) do not fully respond to the first antidepressant. While switching antidepressants is a common strategy for antidepressant nonresponders, there is still a lack of consensus about the optimal timing of a switch. Many clinicians wait for 6-12 weeks before considering a switch. The objectives of this paper are to (1) review the evidence for positive and negative predictive value (NPV) of early improvement at 2-4 weeks to predict final antidepressant response; (2) review randomized controlled trials (RCTs) that examine early switching strategies; and (3) provide future research directions and clinical recommendations for timing of antidepressant switching. We conducted a literature search for English

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Section: Controlled Studies Of Early-switch Strategiesmentioning

confidence: 88%

Section: Controlled Studies Of Early-switch Strategiesmentioning

confidence: 99%

Section: Limitations Of the Evidencementioning

confidence: 99%

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

2014

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“…In patients who failed to show 20% improvement in Montgomery-Å sberg Depression Rating Scale scores after 2 weeks of sertraline treatment in a randomized open-label trial, switching to a second medication (paroxetine) was associated with significantly higher rates of responders and remitters at week 8 compared with continuation of sertraline therapy. 41 For patients who do meet early improvement thresholds at week 2 or 3, the physician should nonetheless continue to monitor symptoms closely to ensure continued improvement throughout their acutephase treatment, as almost half of such patients may still fail to remit with continued treatment.…”

Section: Discussionmentioning

confidence: 99%

Early Improvement in Depressive Symptoms With Desvenlafaxine 50 mg/d as a Predictor of Treatment Success in Patients With Major Depressive Disorder

Soares¹,

Fayyad²,

Guico-Pabia³

2014

Journal of Clinical Psychopharmacology

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“…This procedure has been widely used in previous studies of the response to paroxetine or antidepressants 14,22,23. A Student’s t -test and a chi-squared test were performed to compare demographic data and MADRS scores between responders and non-responders and between male and female participants.…”

Section: Methodsmentioning

confidence: 99%

Sex differences in the prediction of the effectiveness of paroxetine for patients with major depressive disorder identified using a receiver operating characteristic curve analysis for early response

Tomita

Yasui‐Furukori

Sato

et al. 2014

NDT

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BackgroundWe investigated cutoff values for the early response of patients with major depressive disorder to paroxetine and their sex differences by using a receiver operating characteristic (ROC) curve analysis to predict the effectiveness of paroxetine.MethodsIn total, 120 patients with major depressive disorder were enrolled and treated with 10–40 mg/day paroxetine for 6 weeks; 89 patients completed the protocol. A clinical evaluation using the Montgomery–Asberg Depression Rating Scale (MADRS) was performed at weeks 0, 1, 2, 4, and 6.ResultsIn male subjects, the cutoff values for MADRS improvement rating in week 1, week 2, and week 4 were 20.9%, 34.9%, and 33.3%, respectively. The sensitivities and the specificities were 83.3% and 80.0%, 83.3% and 80.0%, and 100% and 90%, respectively. The areas under the curve (AUC) were 0.908, 0.821, and 0.979, respectively. In female subjects, the cutoff values for the MADRS improvement rating in week 1, week 2, and week 4 were 21.4%, 35.7%, and 32.3%, respectively. The sensitivities and the specificities were 71.4% and 84.6%, 73.8% and 76.9%, and 90.5% and 76.9%, respectively. The AUCs were 0.781, 0.735, and 0.904, respectively.ConclusionEarly improvement with paroxetine may predict the long-term response. The accuracy of the prediction for the response is higher in male subjects.

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

Cited by 38 publications

References 46 publications

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

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

Early Improvement in Depressive Symptoms With Desvenlafaxine 50 mg/d as a Predictor of Treatment Success in Patients With Major Depressive Disorder

Sex differences in the prediction of the effectiveness of paroxetine for patients with major depressive disorder identified using a receiver operating characteristic curve analysis for early response

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