Switching and combining strategies of antidepressant medications

• Published in: La Presse médicale (1983) 2016-03, Vol.45 (3), p.329-337
• Main Authors: Charpeaud, Thomas, Moliere, Fanny, Bubrovszky, Maxime, Haesebaert, Frédéric, Allaïli, Najib, Bation, Rémy, Nieto, Isabel, Richieri, Raphaëlle, Saba, Ghassen, Bellivier, Frank, Bennabi, Djamila, Holtzmann, Jérôme, Camus, Vincent, Courtet, Philippe, Courvoisier, Pierre, d'Amato, Thierry, Doumy, Olivier, Garnier, Marion, Bougerol, Thierry, Lançon, Christophe, Haffen, Emmanuel, Leboyer, Marion, Llorca, Pierre-Michel, Vaiva, Guillaume, El-Hage, Wissam, Aouizerate, Bruno
• Format: Article
• Language: fre
• Subjects: Antidepressive Agents - adverse effects; Antidepressive Agents - classification; Antidepressive Agents - pharmacokinetics; Antidepressive Agents - therapeutic use; Depressive Disorder - drug therapy; Drug Administration Schedule; Drug Interactions; Drug Resistance; Drug Substitution; Drug Therapy, Combination; Humans; Practice Guidelines as Topic
• ISSN: 2213-0276
• DOI: 10.1016/j.lpm.2016.02.003

Switching antidepressant medication may be helpful in depressed patients having no benefit from the initial antidepressant treatment. Before considering switching strategy, the initial antidepressant treatment should produce no therapeutic effect after at least 4 weeks of administration at adequate dosage. Choosing an antidepressant of pharmacologically distinct profile fails to consistently demonstrate a significant superiority in terms of effectiveness over the switching to another antidepressant within the same pharmacological class. Augmenting SSRI/SNRIs with mirtazapine/mianserin has become the most recommended strategy of antidepressant combinations. Augmenting SSRI with tricyclic drugs is now a less recommended strategy of antidepressant combinations given the increased risk for the occurrence of pharmacokinetic drug-drug interactions and adverse effects.