Consider The Evidence: Med/Peds Journal Roundup

March 27, 2006

Depression: if at first you dont succeed

Filed under: Depression, NEJM, SSRI — medblog @ 10:18 pm

NEJM 3/23 – Two articles focusing on the pharmacotherapy of depression appear in the New England Journal this week.

Rush et al present a study of 787 patients with depression that had failed to achieve remission with SSRI therapy. The patients were switched from citalopram to either Buproprion, Sertraline, or Venlafaxine. Although approximately one-quarter of the subjects achieved remission after the switch, the rates were about equal among all three drugs. In other words, it did not seem to matter whether the switch was within class, or to a completely new class of drug.

Trivedi et al. present a study examining the commonly used augmentation strategy for treating resistant depression. The study randomized patients on citalopram therapy that had not achieved remission to recieve either buproprion or buspirone as an additional medication. Although about 30 percent of patients in either group achieved remission, the buproprion group had lower depression scores, and a lower dropout rate.

These studies show that switching or adding a medication to treat depression can improve remission rates. However, the factors that determine whether one particular drug will work for a given patient are still a mystery. Until that issue is answered, treatment remains a trial-and-error process.


Rush, A.
John, Trivedi, Madhukar H., Wisniewski, Stephen R., Stewart, Jonathan
W., Nierenberg, Andrew A., Thase, Michael E., Ritz, Louise, Biggs,
Melanie M., Warden, Diane, Luther, James F., Shores-Wilson, Kathy,
Niederehe, George, Fava, Maurizio, the STAR*D Study Team,
Bupropion-SR, Sertraline, or Venlafaxine-XR after Failure of SSRIs for Depression
N Engl J Med 2006 354: 1231-1242

Trivedi, Madhukar H., Fava, Maurizio, Wisniewski, Stephen R., Thase,
Michael E., Quitkin, Frederick, Warden, Diane, Ritz, Louise,
Nierenberg, Andrew A., Lebowitz, Barry D., Biggs, Melanie M., Luther,
James F., Shores-Wilson, Kathy, Rush, A. John, the STAR*D Study Team,
Medication Augmentation after the Failure of SSRIs for Depression
N Engl J Med 2006 354: 1243-1252



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