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Visual Abstract
Bupropion-SR, Sertraline, or Venlafaxine-XR after Failure of SSRIs for Depression
A. John Rush, M.D., Madhukar H. Trivedi, M.D., Stephen R. Wisniewski, Ph.D., Jonathan W. Stewart, M.D., et al., for the STAR*D Study Team
Reviewed by Charles Li, MD
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Key Question:
When an SSRI doesn't work, should you try another one?
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What they found:
Around 1 in 4 patients who switch to another antidepressant will show improvement, according to one study.
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How they did it:
Researchers conducted a randomized controlled trial of 727 patients who didn't show improvement on Celexa.
Visual Abstract
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Background
SSRIs such as Celexa (citalopram) are excellent treatments for depression and anxiety.
However, they don't always work for everyone. Some people don't manage to improve as much as they need to. Others experience intolerable side effects.
Researchers in this clinical trial wanted to see whether switching antidepressants could help patients who didn't improve on Celexa, an SSRI.
Study Quote
After unsuccessful treatment for depression with a selective serotonin-reuptake inhibitor (SSRI), it is not known whether switching to one antidepressant is more effective than switching to another....
Methods
The researchers studied 727 patients for whom Celexa (citalopram) didn't work. The patients either didn't show improvement on Celexa, or they had intolerable side effects.
The researchers randomly assigned these 727 patients to take one of three other anti-depressants to see whether they would improve on a different antidepressant.
Researchers measured improvement with two standardized depression questionnaires.
Results
They found that all three antidepressants could successfully treat depression in some patients.
Both the HRSD-17 and QIDS-SR-16 showed similar improvements in patients.
There were no statistically significant differences in side effects between the three treatments.
Researchers found that when an SSRI doesn't work, switching antidepressants can work in around 20-25% of patients.
Conclusion
Based on these data, researchers concluded that switching to either of the three medications presented here is a good option for patients who don't benefit from their first try at an SSRI.
While not everyone will show success, around 1 in 4 will experience remission of their depression symptoms.
Study Quote
After unsuccessful treatment with an SSRI, approximately one in four patients had a remission of symptoms after switching to another antidepressant. Any one of the medications in the study provided a reasonable second-step choice for patients with depression. (ClinicalTrials.gov number, ...
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Visual Abstract
A randomized controlled trial found that switching antidepressants can help around 20-25% of patients who didn't benefit from their first SSRI.