Most Read Articles
Roshini Claire Anthony, 11 Sep 2019

Beta-blockers could reduce mortality risk in patients with heart failure with reduced ejection fraction (HFrEF) and moderate or moderately-severe renal dysfunction without causing harm, according to the BB-META-HF* trial presented at ESC 2019.

Elvira Manzano, Yesterday

The US Preventive Services Task Force (USPSTF), in an update of its 2013 recommendations, called on clinicians to offer risk-reducing medications to women who are at increased risk for breast cancer but at low risk for adverse effects.

Pearl Toh, 2 days ago
The use of SGLT-2* inhibitors was not associated with a higher risk of severe or nonsevere urinary tract infections (UTIs) in patients with type 2 diabetes (T2D) compared with DPP**-4 inhibitors or GLP-1*** receptor agonists, a population-based cohort study shows.
5 days ago
In type 2 diabetes patients taking sulfonylureas, hypoglycaemia duration is longer at night and is inversely correlated with the level of glycated haemoglobin (HbA1c), a new study reports.

Antidepressant switching: If one does not work, switch to another

08 Aug 2019

Switching from a tricyclic antidepressant (TCA) to a selective serotonin reuptake inhibitor (SSRI), or the other way around, following failure of or side-effects to the first antidepressant appears to be a viable strategy to achieve response among patients with major depressive disorder (MDD), a study has found.

The study included 811 adult patients with MDD treated with nortriptyline or escitalopram for up to 12 weeks. Of these, 72 switched from nortriptyline to escitalopram after a mean of 6.2 weeks and 36 from escitalopram to nortriptyline after a mean of 7.0 weeks. Reasons for switching included side-effects (n=12), nonresponse (n=34) or both (n=60), whereas no data regarding reason for switching were given in two patients.

Researchers followed the patients for 26 weeks after switching to measure response using the Montgomery–Åsberg Depression Rating scale (MADRS). They found that switching led to a marked reduction in MADRS scores, from a mean of 24.2 at baseline to 18.2 at the end of follow-up among escitalopram-to-nortriptyline switchers (β, −0.38, 95 percent CI, −0.51 to −0.25; p<0.001) and from 21.5 to 15.1 among nortriptyline-to-escitalopram switchers (β, −0.34, −0.41 to −0.26; p<0.001).

Frequently recorded adverse reactions to escitalopram were nausea and vomiting (15 percent) and sexual dysfunction (30 percent). Common adverse effects of nortriptyline included dry mouth (80 percent), orthostatic dizziness (32 percent), drowsiness (27 percent) and constipation (24 percent).

Individuals who switched from nortriptyline to escitalopram were predominantly women (71 percent vs 47 percent; p=0.013) and had a younger age at onset of depressive symptoms (29.5 vs 36.8 years; p=0.003).

The findings indicate that switching to an antidepressant with a different receptor profile in the case of side-effects or nonresponse, despite sufficient dose and treatment duration, may improve treatment response, researchers said.

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Most Read Articles
Roshini Claire Anthony, 11 Sep 2019

Beta-blockers could reduce mortality risk in patients with heart failure with reduced ejection fraction (HFrEF) and moderate or moderately-severe renal dysfunction without causing harm, according to the BB-META-HF* trial presented at ESC 2019.

Elvira Manzano, Yesterday

The US Preventive Services Task Force (USPSTF), in an update of its 2013 recommendations, called on clinicians to offer risk-reducing medications to women who are at increased risk for breast cancer but at low risk for adverse effects.

Pearl Toh, 2 days ago
The use of SGLT-2* inhibitors was not associated with a higher risk of severe or nonsevere urinary tract infections (UTIs) in patients with type 2 diabetes (T2D) compared with DPP**-4 inhibitors or GLP-1*** receptor agonists, a population-based cohort study shows.
5 days ago
In type 2 diabetes patients taking sulfonylureas, hypoglycaemia duration is longer at night and is inversely correlated with the level of glycated haemoglobin (HbA1c), a new study reports.