Accelerating response to antidepressant treatment in depression: a review and clinical suggestions.
OBJECTIVE
The primary objective of this article is to review the literature regarding the speed of response to antidepressant drugs and potential strategies to accelerate the antidepressant response in new antidepressant-free patients with depression. Based on these data, we try to propose both an effective and safe antidepressant treatment strategy to alleviate depressive symptoms at the earliest opportunity.


METHODS
Data were identified by searches of Medline (1966 to September 2009) and references from relevant articles and books. Search terms included depression, antidepressant, predictor, response, onset, acceleration, and augmentation. As our focus was on the acute phase treatment of depression, articles relevant to treatment-resistant depression were excluded. Only articles written in English or Japanese were consulted.


METHODS
Studies, reviews, and books pertaining to the treatment of depression with a special regard to accelerating therapeutic effects were selected.


RESULTS
Most of the available treatment guidelines for major depressive disorders recommend the continuous use of antidepressants for 4 to 8 weeks based on the idea of a delayed onset of response to these drugs. Contrary to this conventional belief, the recent data indicate that antidepressants start to exert their effects within 2 weeks and early non-response could predict a subsequent unfavorable outcome.


CONCLUSIONS
These findings suggest the need of revisiting the timing of an antidepressant switch for early non-responders, whereby switching could be commenced in as early as 2 weeks.
Nakajima
Shinichiro
S
Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan. shinichiro_nakajima@hotmail.com
Suzuki
Takefumi
T
Watanabe
Koichiro
K
Kashima
Haruo
H
Uchida
Hiroyuki
H
D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy*; D004357:Drug Synergism; D017408:Guidelines as Topic; D006801:Humans; D016239:MEDLINE / Q000706:statistics & numerical data
D000928:Antidepressive Agents; D014150:Antipsychotic Agents