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J Affect Disord. 2020 Jan 15;261:160-163. doi: 10.1016/j.jad.2019.09.082. Epub 2019 Sep 30.

Switching antidepressants in the treatment of major depression: When, how and what to switch to?

Author information

1
Treatment Algorithm Group (TAG), Australia; Discipline of Psychiatry, Sydney Medical School, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.
2
Treatment Algorithm Group (TAG), Australia; Department of Psychiatry, University of Melbourne, Melbourne, Vic., Australia.
3
Treatment Algorithm Group (TAG), Australia; Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia; Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.
4
Treatment Algorithm Group (TAG), Australia; University of Western Australian Medical School, Faculty of Health and Medical Science, University of Western Australia, Perth, WA, Australia.
5
Treatment Algorithm Group (TAG), Australia; Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany.
6
Treatment Algorithm Group (TAG), Australia; Department of Psychological Medicine, University of Otago - Christchurch, Christchurch, New Zealand.
7
Treatment Algorithm Group (TAG), Australia; School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; School of Medicine, IMPACT Strategic Research Centre, Deakin University, Barwon Health, Geelong, Vic., Australia.
8
Treatment Algorithm Group (TAG), Australia; School of Medicine, IMPACT Strategic Research Centre, Deakin University, Barwon Health, Geelong, Vic., Australia.
9
Treatment Algorithm Group (TAG), Australia; Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia; Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia. Electronic address: gin.malhi@sydney.edu.au.

Abstract

BACKGROUND:

Switching antidepressant medications is recommended when an initial antidepressant is not effective, when it is unable to be tolerated or when there are significant drug interactions. The aim of this paper is to review the evidence regarding when to switch antidepressants and the optimal approach to switching.

METHODS:

Clinical and academic experts in mood disorders from Australia and New Zealand (Treatment Algorithm Group, TAG) met to discuss the key considerations regarding switching antidepressants in the treatment of depression and formulate recommendations about switching strategies.

RESULTS:

While switching is recommended, there is limited data to guide on how best to approach switching antidepressants (e.g. whether to switch within class or out of class), and how to define the best time to consider switching. Broadly, switching within class after non-response is recommended for mild-moderate depression and out-of-class for patients with a more severe depression or melancholia.

LIMITATIONS:

There is a limited evidence-base to draw on to make definitive recommendations on switching approaches.

CONCLUSIONS:

Switching antidepressants is an appropriate strategy to use if there is a minimal response to an initial antidepressant. Further research is required to determine the optimal switching approach.

KEYWORDS:

Major depression; Switching antidepressants; Treatment non-response; Treatment resistance

PMID:
31630037
DOI:
10.1016/j.jad.2019.09.082

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