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Systematic review
No evidence for switching antidepressants in treatment-resistant depressed patients
  1. Michael E Thase
  1. University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
  1. Correspondence to Michael E Thase
    3535 Market Street, Suite 670, Philadelphia, PA 19104, USA; thase{at}

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Bschor and Baethge conducted a systematic review and meta-analysis of double-blind controlled studies by comparing switching antidepressants versus continuing the ineffective antidepressant. This topic is important because antidepressants are the most widely used treatment of depression in most countries, and many people do not respond to the first course of therapy. Although meta-analyses have evaluated switching antidepressants1 2 and various adjunctive strategies,3,,5 the relatively simple strategy of continuing an erstwhile ineffective antidepressant for an additional 6–8 weeks had previously not been systematically evaluated.

A Meager Harvest

Among more than 2200 studies searched in the Cochrane database, the authors identified only three studies that met the following criteria: adults with major depressive disorder who had not responded to at least 4 weeks of antidepressant therapy and were randomly assigned to double-blind therapy with either the initial medication or another antidepressant. They found no evidence to support switching antidepressants versus simply continuing the initial therapy. Among the three studies, the smallest one reported a trend that favoured switching, whereas the trend was reversed in the two larger studies. The authors concluded that there is insufficient evidence to support switching antidepressants as the …

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  • Competing interests MT has received consultancy fees, speakers fees and/or grants from: Adolar, AstraZeneca, Bristol-Myers Squibb Company, Eli Lilly, Forest Pharmaceuticals, GlaxoSmithKline, Janssen Pharmaceutica, Lundbeck, MedAvante, Merck, Neuronetics, Novartis, Pharmaneuroboost, Otsuka, Pfizer, PGx Pharmaceuticals, Sepracror, Shire US, Supernus Pharmaceuticals, Takeda and Transcept.