Treatment strategies in patients with major depression not responding to first-line sertraline treatment

Licht, Rasmus Wentzer; Qvitzau, Susanne

doi:10.1007/s00213-002-0999-0

Cited by 102 publications

(23 citation statements)

References 19 publications

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“…Of the 7 included RCTs, 2 investigated pharmacotherapy with fluoxetine ( n = 448) [21,22], sertraline ( n = 272) [23,24], and paroxetine ( n = 146) [25,26], whereas 1 study examined duloxetine ( n = 255) [27] and maprotiline ( n = 87) [25]. In the individual trials, the number of participants ranged from 60 [26] to 371 [21] (mean = 151.0 ± 112.9 patients), and trial duration varied between 3 [25] and 8 weeks [27] (mean = 5.0 ± 1.6 weeks).…”

Section: Resultsmentioning

confidence: 99%

Dose Escalation of Antidepressants in Unipolar Depression: A Meta-Analysis of Double-Blind, Randomized Controlled Trials

Dold¹,

Bartova²,

Rupprecht³

et al. 2017

Psychother Psychosom

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Background: As many patients with unipolar depression do not respond sufficiently to initial antidepressant monotherapy, a dose increase of the current administered antidepressant (dose escalation, high-dose treatment) is frequently carried out as next treatment measure. Methods: We conducted a meta-analysis which included all double-blind randomized controlled trials (RCTs) comparing a dose increase of antidepressants directly to continuation of standard-dose treatment in unipolar depressive patients who were non- responders to standard-dose pharmacotherapy. A mean change in the Hamilton Rating Scale for Depression (HAM-D) total score was the primary outcome. Secondary outcomes were response rates and discontinuation rates due to any reason, inefficacy, and adverse effects. Hedges g and risk ratios were calculated as effect sizes. Results: Seven double-blind RCTs (8 study arms) representing 1,208 participants were included. Fluoxetine (N [number of studies] = 2, n [number of patients] = 448), sertraline (N = 2, n = 272), paroxetine (N = 2, n = 146), duloxetine (N = 1, n = 255), and maprotiline (N = 1, n = 87) were investigated. Dose escalation was not more efficacious in HAM-D total score reduction than maintaining standard-dose treatment, neither for the pooled antidepressant group (N = 7, n = 999; Hedges g = -0.04, 95% CI: -0.20 to 0.12; p = 0.63) nor the individual antidepressants. No differences could be determined for response rates, all-cause discontinuation, and drop-outs due to inefficacy. Significantly more patients in the dose escalation group dropped out due to adverse effects than in the standard-dose continuation group. The metaregressions indicate no influence of baseline symptom severity or amounts of dose increments on effect sizes. Conclusions: According to our meta-analytic findings, dose escalation after initial non-response to standard-dose pharmacotherapy cannot be regarded as general evidence-based treatment option in unipolar depression.

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Section: Resultsmentioning

confidence: 99%

Dose Escalation of Antidepressants in Unipolar Depression: A Meta-Analysis of Double-Blind, Randomized Controlled Trials

Dold¹,

Bartova²,

Rupprecht³

et al. 2017

Psychother Psychosom

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“…The number needed to treat (NNT) for the combination was 4 patients for 1 remission beyond what would be expected for fluoxetine alone. A more recent RCT has shown that adding mianserin to sertraline nonresponders offered no advantage over adding placebo [50]. However, the initial trial of sertraline monotherapy was brief and a dose increment of sertraline was carried out 2 weeks prior to randomization, thereby confounding the interpretation of the results.…”

Section: Resultsmentioning

confidence: 99%

The Integrative Management of Treatment-Resistant Depression: A Comprehensive Review and Perspectives

Carvalho

Berk

Hyphantis

et al. 2014

Psychother Psychosom

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Background: Major depressive disorder is a prevalent and disabling illness. Notwithstanding numerous advances in the pharmacological treatment of depression, approximately 70% of patients do not remit after first-line antidepressant treatment. Methods: The MEDLINE/PubMed, EMBASE and ClinicalTrials.gov electronic databases were searched from inception to October 1, 2013, for randomized controlled trials (RCT), relevant open-label trials, meta-analyses and ongoing trials of pharmacological and psychotherapeutic approaches to treatment-resistant depression (TRD). Results: Switching to a different antidepressant is a useful option following nonresponse to a first-line agent. Although widely used in clinical practice, there is limited evidence to support antidepressant combination for TRD. Notwithstanding evidence for lithium or T₃ augmentation to be successful in TRD, most studies were carried out when participants were treated with tricyclic antidepressants (TCA). Of the available strategies to augment the response to new-generation antidepressants, the use of some atypical antipsychotics is best supported by evidence. Several novel therapeutic options are currently discussed. Evidence suggests that cognitive therapy (CT) is an effective strategy for TRD. Conclusions: The success of switching to a different antidepressant following a first-line agent is supported by evidence, but there is limited evidence for effective combination strategies. Lithium and T₃ augmentation of TCA have the strongest evidence base for successful treatment of TRD. The use of augmentation of newer-generation antidepressants with atypical antipsychotics is supported by a growing evidence base. Current evidence supports CT as an effective strategy for TRD. There is a need for additional large-scale RCT of TRD. The development of new antidepressants targeting novel pathways opens a promising perspective for the management of TRD.

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“…The remission rate was also over twice as great in the mianserin+fluoxetine group vs the placebo+fluoxetine group (Ferreri et al, 2001). A recent double-blind study (mianserin+sertraline vs placebo+sertraline) failed to observe beneficial effects of adding mianserin (30 mg/day) to sertraline (100 mg/day) in patients failing to respond to an initial open 6-week treatment with sertraline (50 mg/day Â 4 weeks; 100 mg/day Â 2 weeks; Licht and Qvitzau, 2002). Differences in depression severity may have contributed to these differences.…”

Section: Mirtazapine and Mianserin: Clinical Activity In Major Depresmentioning

confidence: 99%

“…Differences in depression severity may have contributed to these differences. The 17-item HAM-D scores required for study entry was X25 for the fluoxetine augmentation study after initial fluoxetine treatment (Ferreri et al, 2001), whereas the entry criterion was X18 for the sertraline augmentation study before the initial sertraline treatment (Licht and Qvitzau, 2002).…”

Section: Mirtazapine and Mianserin: Clinical Activity In Major Depresmentioning

confidence: 99%

Synergistic Action of 5-HT2A Antagonists and Selective Serotonin Reuptake Inhibitors in Neuropsychiatric Disorders

Marek

Carpenter

McDougle

et al. 2002

Neuropsychopharmacol

239

120

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Recently, the addition of drugs with prominent 5-HT 2 receptor antagonist properties (risperidone, olanzapine, mirtazapine, and mianserin) to selective serotonin reuptake inhibitors (SSRIs) has been shown to enhance therapeutic responses in patients with major depression and treatment-refractory obsessive-compulsive disorder (OCD). These 5-HT 2 antagonists may also be effective in ameliorating some symptoms associated with autism and other pervasive developmental disorders (PDDs). At the doses used, these drugs would be expected to saturate 5-HT 2A receptors. These findings suggest that the simultaneous blockade of 5-HT 2A

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Treatment strategies in patients with major depression not responding to first-line sertraline treatment

Abstract: After 6 weeks of insufficient antidepressant treatment with 50-100 mg/day sertraline, a continued treatment with 100 mg/day sertraline can be considered until at least week 8 before considering changing strategy, unless the condition deteriorates.

Cited by 102 publications

References 19 publications

Dose Escalation of Antidepressants in Unipolar Depression: A Meta-Analysis of Double-Blind, Randomized Controlled Trials

Dose Escalation of Antidepressants in Unipolar Depression: A Meta-Analysis of Double-Blind, Randomized Controlled Trials

The Integrative Management of Treatment-Resistant Depression: A Comprehensive Review and Perspectives

Synergistic Action of 5-HT2A Antagonists and Selective Serotonin Reuptake Inhibitors in Neuropsychiatric Disorders

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