Original ArticleTreatment of SSRI-Resistant Depression: A Meta-Analysis Comparing Within- Versus Across-Class Switches
Section snippets
Data Sources and Search Strategy
Six search strategies were employed to help identify studies for inclusion in the meta-analysis.
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Studies were first identified using searches of PubMed/MEDLINE. Searches were conducted by first cross-referencing the term resistant and then the term switching with each of the six following terms: fluoxetine, sertraline, paroxetine, citalopram, escitalopram, and fluvoxamine. The search was limited to randomized controlled trials.
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These searches were then repeated using EMBASE.
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We also obtained the
Results
Initially, 75 abstracts were identified with the use of PubMed/MEDLINE. Of these, 72 did not meet the inclusion criteria (review articles, other topics). The remaining three abstracts described clinical trials comparing switching to different classes of antidepressants for SSRI-resistant depression (10, 11, 16). These three articles were obtained and reviewed thoroughly. Two of these articles met criteria for inclusion in the meta-analysis (10, 11). The third article was excluded because it
Discussion
In this meta-analysis of randomized clinical trials examining the efficacy of switching to a second SSRI versus a non-SSRI antidepressant for patients with MDD who had not responded to an initial course of SSRI therapy, we found evidence supporting a switch to a non-SSRI rather than an SSRI. Specifically, across studies, there was a modest relative advantage in remission rates for patients switched to the non-SSRI antidepressants compared with those who were switched to a second trial within
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