Antidepressant Nonresponse: How Early to Switch?

In depressed patients not responding to initial SSRI treatment, this large study shows only slight benefits of switching to another antidepressant at 4 rather than 8 weeks.

Although nonresponse to initial treatment with selective serotonin reuptake inhibitors (SSRIs) in depressed patients is very common, few randomized studies (other than STAR*D) have evaluated next-step strategies, and no studies have evaluated the optimal timing for an antidepressant switch. In this multistep, 60-site, European, manufacturer-sponsored trial, researchers examined earlier versus later switches (4 vs. 8 weeks) from escitalopram to duloxetine, a serotonin-norepinephrine reuptake inhibitor.

Of the 840 enrolled adults with depression who started 10 mg escitalopram, 566 were nonresponders at 4 weeks (<30% reduction in Hamilton Rating Scale for Depression [HRSD] scores) and were randomized to switch to 60–120 mg duloxetine immediatel…

Reviewing Author

Peter Roy-Byrne, MD

Disclosures

Editorial BoardsUpToDate

Peter Roy-Byrne, MD

Disclosures

Editorial BoardsUpToDate

Antidepressant Nonresponse: How Early to Switch?

Topics

Reviewing Author