Management of Nonresponse and Intolerance: Switching Strategies

Approximately 29% to 46% of depressed patients show only partial or no response to treatmentwith antidepressants, with intolerance a frequent cause of treatment failure or discontinuation. Cliniciansfrequently switch to other antidepressants patients who have failed to tolerate or to respond toantidepressant treatment. The switching strategy involves substitution of another agent for the agentthat has either caused intolerable side effects or has failed to induce a response. Fredman and colleagueshave recently surveyed 402 psychiatrists from various parts of the country and asked themwhat steps they would take for patients who fail to respond to 8 weeks or more of an adequate dose ofa selective serotonin reuptake inhibitor (SSRI). Interestingly, switching to a non-SSRI agent was themost popular choice indicated by psychiatrists (44% of respondents), with dual-acting agents and bupropionbeing the next most commonly chosen agents. Even though there are no controlled trials ofswitching strategies in the literature to date, clinicians often choose this course of action. This articlewill review some of the currently available studies on switching strategies.