When one antidepressant doesn't work, another may

NEW YORK (Reuters Health) - For people suffering from depression that doesn't respond to treatment with one type of antidepressant, switching to a different type may be the best treatment, according to a new report.

Relatively new antidepressants such as Prozac and Zoloft, for example, are called selective serotonin reuptake inhibitors or SSRIs. In recent clinical trials, only about a third of depressed patients achieved remission with SSRI treatment, the authors explain, but there is little consensus among psychiatrists about the best treatment for patients when an SSRI doesn't work.

To look into this, Dr. George I. Papakostas from Harvard Medical School, Boston, and his associates conducted an analysis of four clinical trials that compared a switch to a second SSRI versus a non-SSRI antidepressant for SSRI-resistant major depression.

The pooled data included 1496 patients who had not responded to treatment with one SSRI and were subsequently randomly assigned to treatment with another SSRI or a non-SSRI antidepressant.

Patients randomized to switch to a non-SSRI antidepressant were slightly more likely to experience remission than patients who were switched to a second SSRI, the researchers report in the medical journal Biological Psychiatry.

However, the non-SSRI antidepressants were somewhat less well tolerated than the SSRIs.

The results indicate that current treatments for depression are still less than ideal. "There continues to be a pressing need to introduce new antidepressant medications," comments Dr. John Krystal, the journal's editor.

SOURCE: Biological Psychiatry, April 1, 2008.