title: How to switch to agomelatine after an unsuccessful try with paroxetine or venlafaxine.
abstract: OBJECTIVE
  The present trial informs clinicians about switching conditions with the antidepressant agomelatine after the failure of a treatment with either paroxetine or venlafaxine.
  
  
  METHODS
  The total number of discontinuation-emergent symptoms, according to the Discontinuation-Emergent Signs and Symptoms checklist, was compared in double-blind conditions after 3 switching options: immediate substitution or initiation of agomelatine (25 mg/day p.o.) with either a short- or long-tapering of the previous drug. Secondary objectives included tolerability and safety assessments and the early clinical benefit after the switch.
  
  
  RESULTS
  For all switching options, a withdrawal syndrome was observed 1 week after cessation of the selective serotonin reuptake inhibitor (SSRI)/serotonin-norepinephrine reuptake inhibitor (SNRI) treatment. Psychic symptoms were the most frequently reported, and somatic symptoms were comparatively few. Early discontinuation symptoms after cessation of SSRI/SNRI treatment did not prejudice the antidepressant benefits of agomelatine over 8 weeks.
  
  
  CONCLUSIONS
  Both abrupt and start-taper switching with agomelatine are options in everyday practice for those patients who have not responded to either paroxetine or venlafaxine. However, regardless of the switching strategy, the present double-blind study shows that early discontinuation symptoms that arise upon cessation of SSRI/SNRI can alter the patients' perception of the clinical benefit of the new antidepressant. Both practitioners and patients must be warned about these early discontinuation symptoms to prevent the symptoms from being confounded with a lack of therapeutic benefit of the new treatment.
authors: 1Hôpital Bichat,Claude Bernard 46,Paris,France.
authors: Michel
authors: M
authors: Lejoyeux
authors: 2Institut de Recherches Internationales Servier (IRIS),Suresnes,France.
authors: Sophie
authors: S
authors: Matharan
authors: 2Institut de Recherches Internationales Servier (IRIS),Suresnes,France.
authors: Christian
authors: C
authors: de Bodinat
mesh_terms: D000081:Acetamides / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003511:Cyclohexanols / Q000008:administration & dosage / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy*; D057915:Drug Substitution; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017374:Paroxetine / Q000008:administration & dosage / Q000627:therapeutic use*; D000069470:Venlafaxine Hydrochloride; D009281:Naphthalenes
chemical_list: D000081:Acetamides; D000928:Antidepressive Agents; D003511:Cyclohexanols; D017374:Paroxetine; D000069470:Venlafaxine Hydrochloride; C084711:agomelatine; D009281:Naphthalenes
keywords: Tapering