Universität zu Köln

Bschor, Tom, Kern, Hannah, Henssler, Jonathan ORCID: 0000-0001-8123-5853 and Baethge, Christopher (2018). Switching the Antidepressant After Nonresponse in Adults With Major Depression: A Systematic Literature Search and Meta-Analysis. J. Clin. Psychiatry, 79 (1). S. 11 - 20. MEMPHIS: PHYSICIANS POSTGRADUATE PRESS. ISSN 1555-2101

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Abstract

Objective: Nonresponders to antidepressant monotherapy during acute treatment of major depression are often switched to a new antidepressant. The objective of this meta-analysis was to compare the efficacy of switching to a new antidepressant with continuation of the first antidepressant. Data Sources: PubMed, Embase, PsycINFO, and Cochrane Central Register of Controlled Trials (CENTRAL) databases and additional sources were systematically searched independently by 2 authors up to March 2015 without language limitations. With employment of a sensitivity-enhancing search strategy, generic terms for major depression, switching, and randomized trials were combined. Study Selection: Articles (3,234) were screened for trials of patients with major depression who had not responded to antidepressant monotherapy who were then randomized either to a new antidepressant or to continuation of the first antidepressant. Studies were subdivided into those not allowing for dose escalation in the continuation arm (strict analysis) and those allowing for dose escalation (broad analysis). Data Extraction: Data were extracted and risk of bias was assessed independently by 2 authors, and data were pooled using random effects models. Results: Four randomized controlled trials were included in the strict analysis and 8 in the broad analysis. In both analyses, switching was not superior to continuation: the standardized mean difference in the strict analysis was -0.17 (95% CI, -0.59 to 0.26; P =.45; I-2 = 77.8%) and in the broad analysis was 0.031 (95% CI, -0.26 to 0.32; P =.836; I-2 = 85.3%). All secondary outcome analyses (response and remission rates, low risk of bias studies only, leave-one-out analysis, dropouts) supported the results. There was no indication of publication bias. Conclusions: There is a dearth of randomized controlled trials investigating switching. There is no high-level evidence that switching the antidepressant is effective when compared to simply continuing the initial antidepressant. Since there are better treatment options than switching, physicians should be cautious to switch antidepressants.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Bschor, Tom UNSPECIFIED UNSPECIFIED UNSPECIFIED Kern, Hannah UNSPECIFIED UNSPECIFIED UNSPECIFIED Henssler, Jonathan UNSPECIFIED orcid.org/0000-0001-8123-5853 UNSPECIFIED Baethge, Christopher UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-202497
DOI:	10.4088/JCP.16r10749
Journal or Publication Title:	J. Clin. Psychiatry
Volume:	79
Number:	1
Page Range:	S. 11 - 20
Date:	2018
Publisher:	PHYSICIANS POSTGRADUATE PRESS
Place of Publication:	MEMPHIS
ISSN:	1555-2101
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language TREATMENT-RESISTANT DEPRESSION; PSYCHIATRY WFSBP GUIDELINES; OLANZAPINE/FLUOXETINE COMBINATION; BIOLOGICAL TREATMENT; WORLD FEDERATION; DOSE-ESCALATION; DOUBLE-BLIND; DISORDERS; VENLAFAXINE; EFFICACY Multiple languages Psychology, Clinical; Psychiatry Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/20249