title: Treatment patterns in major depressive disorder after an inadequate response to first-line antidepressant treatment.
abstract: BACKGROUND
  The aim of the study was to determine the most common pharmacological strategies used in the management of major depressive disorder (MDD) after an inadequate response to first-line antidepressant treatment in clinical practice.
  
  
  METHODS
  Multicenter, non-interventional study in adult outpatients with a DSM-IV-TR diagnosis of MDD and inadequate response to first-line antidepressant medication. Multiple logistic regression analyses were performed to identify independent factors associated with the adoption of a specific second-line strategy.
  
  
  RESULTS
  A total of 273 patients were analyzed (mean age: 46.8 years, 67.8% female). Baseline mean Montgomery-Asberg Depression Rating Scale total score was 32.1 (95%CI 31.2-32.9). The most common strategies were: switching antidepressant medication (39.6%), augmentation (18.8%), and combination therapy (17.9%). Atypical antipsychotic drugs were the most commonly used agent for augmenting antidepressant effect. The presence of psychotic symptoms and the number of previous major depressive episodes were associated with the adoption of augmenting strategy (OR = 3.2 and 1.2, respectively).
  
  
  CONCLUSIONS
  The switch to another antidepressant agent was the most common second-line therapeutic approach. Psychiatrists chose augmentation based on a worse patients' clinical profile (number of previous episodes and presence of psychotic symptoms).
authors.affiliation: Department of Psychiatry, Hospital Son Llatzer, Palma de Mallorca, Spain.
authors.forename: Mauro
authors.initials: M
authors.lastname: Garcia-Toro
authors.forename: Esteban
authors.initials: E
authors.lastname: Medina
authors.forename: Jaime L
authors.initials: JL
authors.lastname: Galan
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Gonzalez
authors.forename: Jorge
authors.initials: J
authors.lastname: Maurino
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000592:standards / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology; D019468:Disease Management; D004357:Drug Synergism; D004359:Drug Therapy, Combination / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales / Q000592:standards; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents