This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

When Should Clinicians Switch Antidepressants?

Frederic M. Quitkin, MD; Patrick J. McGrath, MD; Jonathan W. Stewart, MD; Katja Ocepek-Welikson, MPhil; Bonnie P. Taylor, MA; Edward Nunes, MD; Deborah Deliyannides, MD; Vito Agosti, MSW; Steven J. Donovan, MD; Eva Petkova, PhD; Donald F. Klein, MD

Arch Gen Psychiatry. 1996;53(9):785-792.

Abstract
Background
We attempt to identify the time when patients whose conditions are unimproved while receiving antidepressants are unlikely to respond and should have their treatment changed.

Methods
A total of 593 patients were studied. The course of treatment for patients was examined to determine the weeks at which patients who received drug therapy had a better chance of being rated as responders at the study end (week 6) vs patients who received placebo.

Results
At the end of week 3, 19 (32%) of the 59 patients who received drug therapy and 6 (10%) of the 57 patients who received placebo and who never minimally improved were rated as responders at week 6. For those who showed no improvement by week 4, the effects of drug therapy and the placebo were equal. Patients who received drug therapy and whose conditions were unimproved but who had been minimally improved at some point had a superior prognosis with drug therapy vs placebo until week 4. Of those unimproved at week 4 but minimally improved at some point previously, 20 (39%) of the 51 patients who received drug therapy vs 3 (8%) of the 36 patients who received pIacebo were rated as responders at week 6. Of the 75 patients who minimally improved while receiving drug therapy at the end of week 5, 33 (44%) had a chance of being rated a responder at the end of week 6 vs 9 (26%) of the 35 patients receiving placebo.

Conclusions
Patients tolerant of an adequate dose, whose conditions have never been at least minimally improved by the end of week 4, should have their treatment regimen altered. These patients represented a minority of drug-treated patients in the sample studied (ie, 39/392 [10%]). Patients whose conditions minimally improve at some prior week but not after week 5 should have their treatment changed. Patients whose conditions minimally improve in week 5 should continue treatment until week 6.

Author Affiliations
From the Department of Therapeutics, Columbia University College of Physicians & Surgeons, New York State Psychiatric Institution, New York City.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Duloxetine: A balanced and selective norepinephrine- and serotonin-reuptake inhibitor
Westanmo et al.
Am J Health Syst Pharm 2005;62:2481-2490.
ABSTRACT | FULL TEXT  

Bupropion for Treatment of Interferon-Induced Depression
Malek-Ahmadi and Ghandour
The Annals of Pharmacotherapy 2004;38:1202-1205.
ABSTRACT | FULL TEXT  

When Should a Trial of Fluoxetine for Major Depression Be Declared Failed?
Quitkin et al.
Am. J. Psychiatry 2003;160:734-740.
ABSTRACT | FULL TEXT  

Placebo Response in Studies of Major Depression: Variable, Substantial, and Growing
Walsh et al.
JAMA 2002;287:1840-1847.
ABSTRACT | FULL TEXT  

Strategies for Treatment Refractory Depression
Goren
Journal of Pharmacy Practice 2001;14:478-487.
ABSTRACT  

Withdrawing patients from antidepressants
DTB 1999;37:49-52.
ABSTRACT | FULL TEXT  

Treating Major Depression in Primary Care Practice: An Update of the Agency for Health Care Policy and Research Practice Guidelines
Schulberg et al.
Arch Gen Psychiatry 1998;55:1121-1127.
ABSTRACT | FULL TEXT  

When to Switch Antidepressants
JWatch Psychiatry 1996;1996:3-3.
FULL TEXT