| Comparison and Outcome of Interest | Strength of Evidencea | Findings | |
|---|---|---|---|
| Switch strategies: SGA switch versus SGA switch | Response | Moderate | Results from 2 direct comparisons involving 1,123 patients indicate no substantial differences in response rates between SGAs. |
| Remission | Low | Results from 1 direct comparison involving 727 patients indicate no substantial difference in remission rates between SGAs. | |
| Decrease in depressive severity | Low | Results from 1 direct comparison involving 727 patients indicate no substantial differences in decrease in depressive severity between SGAs. | |
| Discontinuation because of adverse events | Moderate | Results from 1 direct comparison involving 727 patients indicate no substantial differences in rates of discontinuation because of adverse events between SGAs. | |
| Serious adverse events | Low | Results from 1 direct comparison involving 727 patients indicate no substantial differences in rates of serious adverse events between SGAs. | |
| Suicidal ideas or behavior | Low | Results from 1 direct comparison involving 727 patients indicate no substantial differences in rates of suicidal ideas or behavior between SGAs. | |
| Switch strategies: SGA switch versus CT switch | Response, remission, and change in depressive severity | Low | Results from 1 direct comparison of switching to a different SGA versus switching to CT involving 122 patients indicate no substantial differences in rates of response or remission or in the decrease in depressive severity. |
| Discontinuation because of adverse events | Low | Results from 1 direct comparison of switching to a different SGA versus switching to CT involving 122 patients indicate no substantial differences in rates of discontinuation because of adverse events. | |
| Serious adverse events | Insufficient | Based on 1 trial with few events, the evidence is insufficient to draw conclusions. | |
| Augmentation strategies: SGA augment versus SGA augment | Response and remission | Low | Results from 1 direct comparison involving 565 patients indicate no substantial differences in rates of response or remission between SGAs. |
| Decrease in depressive severity | Low | Results from 1 direct comparison involving 565 patients indicate a greater decrease in depressive severity after adding bupropion than buspirone. | |
| Discontinuation because of adverse events | Moderate | Results from 1 direct comparison involving 565 patients indicate lower rates of discontinuation because of adverse events after adding bupropion than buspirone. | |
| Serious adverse events | Low | Results from 1 direct comparison involving 565 patients indicate similar rates of serious adverse events after adding bupropion or buspirone. | |
| Suicidal ideas and behavior | Low | Results from 1 direct comparison involving 565 patients indicate similar rates of suicidal ideas and behavior after adding bupropion or buspirone. | |
| Augmentation strategies: SGA augment versus CT augment | Response, remission, and change in depressive severity | Low | Results from 1 direct comparison involving 182 patients of augmenting with a second medication versus augmenting with CT indicate no substantial differences in rates of response or remission or in the decrease in depressive severity. |
| Discontinuation because of adverse events | Low | Results from 1 direct comparison involving 182 patients of augmenting with a second medication versus augmenting with CT indicate no substantial differences in rates of discontinuation because of adverse events. | |
| Serious adverse events | Low | Results from 1 direct comparison involving 182 patients of augmenting with a second medication versus augmenting with CT indicate no substantial differences in rates of serious adverse events. | |
CT = cognitive therapy; KQ =Key Question; SGA = second-generation antidepressant; SOE = strength of evidence; vs. = versus
SOE grades (high, moderate, low, or insufficient) are based on methods guidance for the AHRQ EPC program.83
From: Discussion
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