How do you choose a second-line treatment option for depression?
A majority of patients with major depression do not remit or adequately respond to initial antidepressant therapy. When response is insufficient, a diagnosis of depression and any comorbidities should be confirmed, treatment adherence should be established, and antidepressant dosages should be optimized as tolerated. If response is still insufficient, then implementing second-line treatment strategies is warranted. Second-line strategies of switching to or combining/augmenting the initial agent with one of a variety of antidepressant medications and/or psychotherapies improves remission rates, although no single approach or agent has demonstrated clear superiority over any other. Second-line treatment selections should be driven by safety considerations, patients' symptom profiles, and patient preference. Comorbid medical conditions, especially cardiac and cerebrovascular complications, and potential drug-drug interactions should be considered when making treatment decisions.
Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA. rweisler@weislermd.com
Richard H
RH
Weisler
D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001526:Behavioral Symptoms / Q000188:drug therapy*; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002561:Cerebrovascular Disorders / Q000453:epidemiology*; D002986:Clinical Trials as Topic; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology* / Q000628:therapy*; D004347:Drug Interactions; D004351:Drug Resistance; D006801:Humans; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index
D000928:Antidepressive Agents