Adverse event rates similar when switching, combining antidepressants
MedWire News: Adding a second antidepressant to an existing one after initial treatment failure is not associated with higher rates of side effects than switching to an alternative monotherapy, suggest study findings.
"While many treatment options exist, little evidence is available to guide treatment selection following initial antidepressant failure. Because evidence is lacking, many next-step treatment decisions are based on clinicians' perceptions of adverse events," say Richard Hansen (Auburn University, Alabama, USA) and co-authors.
"Given the probability for a single antidepressant to cause unintended adverse events, one might assume that the use of two medications through an augmentation strategy may result in a higher probability of adverse events than switching to a different antidepressant monotherapy."
Using public data files from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, the researchers compared adverse event profiles for second-step switch and augment medication strategies among 1292 patients.
Patients with initial unsuccessful citalopram monotherapy were either augmented with bupropion or buspirone, or were switched to monotherapy with sertraline or venlafaxine. Patients were followed-up over a 14-week period to monitor for side effects following a change in therapy.
Study findings revealed an identical number of total and specific adverse events between patients in the augment and switch groups. Although painful urination and sexual dysfunction were more common among patients who augmented their medication than those who switched, the difference was not significant.
The overall incidence proportion of any distressing event was also similar between the groups.
In a press release, Hansen said the study should give physicians treating depression a clear message: "For treatment-resistant depression, the decision to augment or switch medications should be based on individual patient's clinical status, as well as the possible benefits and risks of each treatment."
The findings are published in the General Hospital Psychiatry journal.
By Ingrid Grasmo