Adding another medication rather than switching medications may benefit patients partially responding to initial antidepressant
While antidepressants are effective treatment for major depressive disorder, up to 40 percent of patients may not respond adequately to initial first-line therapy. Options for such patients include switching to another medication or adding an additional medication to the initial treatment. A new study found no clear difference between these strategies in terms of remission of depression, response to medication, or time to remission or response. However, the findings did suggest that those who completed an initial treatment of 12 weeks or more, and had a partial response to the medication with residual mild depression, might benefit more from augmentation of treatment with another medication than from switching medications.
The researchers analyzed the outcomes of a group of patients who had participated in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) clinical trial. All patients (age 18 to 75 years) had failed to respond to an initial antidepressant in the trial. The researchers matched 269 augmenting patients and 269 switching patients to examine remission and medication response.
The likelihood of remission or medication response and time to remission or response were similar in the two groups, and the strategies did not differ in effect on quality of life. The severity of a patient's depression and the number of weeks on initial treatment strongly influenced the propensity to receive augmentation. The superiority of augmentation was most apparent in patients who received 12 weeks of initial treatment. In this case, the augmentation strategy was twice as likely to produce remission as was switching medication. Patients who had partially responded to initial treatment were also more likely to have remission with augmentation than with switching. The study was supported in part by the Agency for Healthcare Research and Quality (Contract No. 290-05-0040).
See "Treating depression after initial treatment failure: directly comparing switch and augmenting strategies in STAR*D," by Bradley N. Gaynes, M.D., M.P.H., Stacie B. Dusetzina, Ph.D., Alan R. Ellis, M.S.W., and others in the February 2012 Journal of Clinical Psychopharmacology 32(1), pp. 114-119.
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