Abstract
Introduction:
Non-response to an antidepressant monotherapy in unipolar depression is quite common.
Therefore strategies for subsequent treatment steps are necessary. However, there
is a lack of direct comparisons of these different strategies. In this naturalistic
study we compared the outcome to different strategies after failure of the primary
antidepressant treatment.
Methods:
Failure of primary antidepressant monotherapy occurred in 135 patients. 98 of these
patients have been administered 4 treatment strategies of the physicians’ choice:
lithium augmentation (Li-Augm), switching to another antidepressant (AD-Switch), combination
of 2 antidepressants (AD-Comb) or augmentation with second generation antipsychotic
(SGA-Augm). Primary outcome measure was the 17-item Hamilton rating scale for depression
(HRSD).
Results:
Patients who received Li-Augm or augmentation with SGAs showed significantly greater
improvement in HRSD and BDI compared to patients with antidepressant switch or antidepressant
combination. Remission rates for Li-Augm and SGA-Augm were 89.3% and 86.2% compared
to 40.7% for AD-Switch and 42.9% for AD-Comb.
Discussion:
Changing to another pharmacological class (Li-Augm or augmentation with SGAs) showed
better treatment results than sticking to the class of antidepressants (AD-Switch
and AD-Comb) after primary failure in response to antidepressant monotherapy in unipolar
depression. The lack of randomization and absence of a non-response definition are
design flaws. Controlled studies are required to confirm the findings of this trial.
Key words depression - depression treatment - antidepressants
