What to Expect When Switching to a Second Antidepressant Medication Following an Ineffective Initial SSRI: A Report From the Randomized Clinical STAR*D Study.

Rush, A John

South, Charles

Jha, Manish K

Jain, Shailesh Bobby

Trivedi, Madhukar H

2022-04-13T23:12:35Z

2022-04-13T23:12:35Z

2020-08-11

2022-04-13T23:12:35Z

OBJECTIVE:An antidepressant medication switch often follows a failed initial trial with selective serotonin reuptake inhibitors (SSRIs). When, for whom, and how often second-step response and remission occur are unclear, as is preferred second-step trial duration. As more treatments are approved for use following 2 failed "adequate" trials, researchers and clinicians require an evidence-based definition of "adequate." METHODS:Following citalopram in the randomized Sequenced Treatment Alternatives to Relieve Depression (STAR*D) clinical trial (which ran July 2001-September 2006), participants with score ≥ 11 on the 16-item Quick Inventory of Depressive Symptomatology-Self-Rated (QIDS-SR₁₆) were randomized to bupropion sustained release, sertraline, or venlafaxine extended release (up to 14 weeks). The QIDS-SR₁₆ defined response, remission, and no clinically meaningful benefit based on the modified intent-to-treat sample. RESULTS:About 80% of 438 participants completed ≥ 6 weeks of treatment with the switch medication. All treatments had comparable outcomes. Overall, 21% (91/438) remitted, 9% (40/438) responded without remission, and 58% (255/438) had no meaningful benefit. Half of the responses and two-thirds of remissions occurred after 6 weeks of treatment. Overall, 33% of responses (43/131) occurred after ≥ 9 weeks of treatment. No baseline features differentiated early from later responders or remitters. No early triage point was found, but those with at least 20% reduction from baseline in QIDS-SR₁₆ score around week 2 were 6 times more likely to respond or remit than those without this reduction. CONCLUSIONS:Following nonefficacy with an initial SSRI, only about 20% remit and more than half achieve no meaningful benefit with a second-step switch to another monoaminergic antidepressant. A 12-week trial duration seems necessary to capture as many second-step switch responders as possible. TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT00021528.

0160-6689

1555-2101

https://hdl.handle.net/10161/24800

eng

Physicians Postgraduate Press, Inc

The Journal of clinical psychiatry

10.4088/jcp.19m12949

Humans

Sertraline

Bupropion

Serotonin Uptake Inhibitors

Antidepressive Agents

Delayed-Action Preparations

Treatment Outcome

Depressive Disorder, Major

Psychiatric Status Rating Scales

Adult

Female

Male

Drug Substitution

Venlafaxine Hydrochloride

What to Expect When Switching to a Second Antidepressant Medication Following an Ineffective Initial SSRI: A Report From the Randomized Clinical STAR*D Study.

Journal article

Rush, A John|0000-0003-2004-2382

5

Duke

School of Medicine

Published

81