Most Read Articles
19 Sep 2016
Sertraline may prevent the onset of depressive disorders after traumatic brain injury (TBI), a randomized trial showed.
Tristan Manalac, 6 days ago
Daily engagement in brief, self-guided mindfulness and relaxation practices eases symptoms of borderline personality disorder in young adults, according to a recent Singapore study.
09 Oct 2016
The use of hormonal contraception increases the risk of subsequent use of antidepressants and a first diagnosis of depression, results of a study show.
01 Dec 2016
Vortioxetine 5-20 mg/day lessens depression and anxiety severity in patients with major depressive disorder (MDD) and high levels of anxiety, as observed in a meta-analysis of 10 randomised, placebo-controlled, 6/8-week trials.

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.

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Psychiatry - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
19 Sep 2016
Sertraline may prevent the onset of depressive disorders after traumatic brain injury (TBI), a randomized trial showed.
Tristan Manalac, 6 days ago
Daily engagement in brief, self-guided mindfulness and relaxation practices eases symptoms of borderline personality disorder in young adults, according to a recent Singapore study.
09 Oct 2016
The use of hormonal contraception increases the risk of subsequent use of antidepressants and a first diagnosis of depression, results of a study show.
01 Dec 2016
Vortioxetine 5-20 mg/day lessens depression and anxiety severity in patients with major depressive disorder (MDD) and high levels of anxiety, as observed in a meta-analysis of 10 randomised, placebo-controlled, 6/8-week trials.