Changing or adding meds is key in refractory depression

Changing or adding meds is key in refractory depression

Level 2 results of the National Institute of Mental Health's STAR*D trial show that 25% of patients who switched to a new antidepressant after having no response to the SSRI citalopram in Level 1 became symptom-free within 14 weeks. Of the 1,439 patients studied, 727 were switched to sertraline (Zoloft, Pfizer), bupropion-SR, or venlafaxine-XR (Effexor-XR, Wyeth) and the improvement of depression was similar for each of the three drugs. Study investigator John Rush, M.D., said the three medications all appear to be useful options for treating depression following failure on the first SSRI, despite having different mechanisms of action. He also said the results will show patients and physicians that intolerance or lack of efficacy with one SSRI does not seem to predict the same with another. Other patients were randomized to receive augment medication with either bupropion-SR or buspirone in addition to the citalopram they were already taking. After 14 weeks, one-third of these patients had remission of the depression symptoms. Those who augmented with bupropion-SR had fewer symptoms of depression, more relief, and fewer side effects compared with patients taking buspirone; however, both combinations were similar in terms of remission. The study was published in the March 23 issue of the New England Journal of Medicine.

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