Citalopram versus desipramine in treatment resistant depression: Effect of continuation or switching strategies. A randomized open study

Daniel Souery, Alessandro Serretti, Raffaella Calati, Pierre Oswald, Isabelle Massat, Anastasios Konstantinidis, Sylvie Linotte, Siegfried Kasper, Stuart Montgomery, Joseph Zohar, Julien Mendlewicz

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives. Evidence in favour of switching between selective serotonin reuptake inhibitor (SSRI) and tricyclic (TCA) antidepressants in treatment resistant depression has been tested in a few studies only, consequently a prospective study was undertaken to evaluate the impact of switching strategies. Methods. One hundred eighty-nine patients who failed to respond to a previous antidepressant were randomised to four arms: firstly they received citalopram or desipramine for a 4-week period; secondly, those who failed to respond were treated for a further 4-week period with the same antidepressant (citalopram-citalopram and desipramine-desipramine arms) or switched to the alternate one (citalopram-desipramine and desipramine-citalopram arms). Results. There was no difference in the first 4-week phase between patients receiving citalopram versus desipramine in Hamilton Rating Scale for Depression (HRSD), MontgomeryAsberg Depression Rating Scale (MADRS), and Clinical Global Impression (CGI) scores. In the second 4-week phase remitter rates were higher among non-switched patients (P = 0.04). Moreover, considering HRSD and MADRS, switched patients reported significantly higher scores (P ≤≠0.02 for both scales at each time-point). Conclusions. This study supports the thesis that switching from an SSRI to a TCA (and vice versa) in non-responders to a 4-week trial of an SSRI/TCA is not associated with improved response. The result goes in the opposite direction to that predicted by current guidelines.

Original languageEnglish
Pages (from-to)364-375
Number of pages12
JournalWorld Journal of Biological Psychiatry
Volume12
Issue number5
DOIs
StatePublished - Aug 2011
Externally publishedYes

Keywords

  • Antidepressants
  • Major depressive disorder
  • Pharmacotherapy
  • Resistant depression
  • Switch

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