Is switching antidepressants following early nonresponse more beneficial in acute-phase treatment of depression? A randomized open-label trial

Shinichiro Nakajima, Hiroyuki Uchida, Takefumi Suzuki, Koichiro Watanabe, Jinichi Hirano, Tatsuhiko Yagihashi, Hiroyoshi Takeuchi, Takayuki Abe, Haruo Kashima, Masaru Mimura

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Rationale: Treatment guidelines for major depressive disorder (MDD) recommend a continuous use of antidepressants for several weeks, while recent meta-analyses indicate that antidepressant efficacy starts to appear within 2. weeks and early treatment nonresponse is a predictor of subsequent nonresponse. Objectives: We prospectively compared 8-week outcomes between switching antidepressants and maintaining the same antidepressant in early nonresponders, to generate a hypothesis on possible benefits of early switching strategy. Method: Patients with MDD without any treatment history for the current episode were included. When subjects failed to show an early response (i.e., ≥ 20% improvement in the Montgomery-Åsberg Depression Rating Scale (MADRS)) to the initial treatment with sertraline 50. mg at week 2, they were randomly divided into two groups; in the Continuing group, sertraline was titrated at 50-100. mg, whereas sertraline was switched to paroxetine 20-40. mg in the Switching group. A primary outcome measure was a response rate (i.e., ≥ 50% improvement in the MADRS) at week 8. Results: Among 132 subjects, 41 subjects showed early nonresponse. The Switching group (n = 20) showed a higher rate of responders than the Continuing group (n = 21) (75% vs. 19%: p = 0.002). Further, the Switching group was also superior in the rate of remitters (total score of ≤ 10 in the MADRS) (60% vs. 14%: p = 0.004) and continuous changes in the MADRS (19.0 vs. 7.5: p < 0.001). Conclusions: Our preliminary findings suggest that patients with MDD who fail to show early response to an initial antidepressant may derive benefits from the early switching antidepressants in the acute-phase treatment of depression.

Original languageEnglish
Pages (from-to)1983-1989
Number of pages7
JournalProgress in Neuro-Psychopharmacology and Biological Psychiatry
Issue number8
Publication statusPublished - 2011 Dec 1



  • Antidepressant
  • Major depressive disorder
  • Onset
  • Predictor
  • Switching

ASJC Scopus subject areas

  • Pharmacology
  • Biological Psychiatry

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