Early switch strategy in patients with major depressive disorder

Major depressive disorder is a highly prevalent and chronic mental disorder. There have been a number of antidepressants with different class employing different pharmacological profiles for treatment of major depressive disorder; however, currently available placebo-controlled or large practical clinical trials demonstrated that the efficacy of antidepressants is quite limited to yield full recovery for such patients. Approximately 30% of major depressive disorder patients remit with initial antidepressant treatment, whereas a chance of recurrence significantly increases with subsequent treatment failures. Hence, most treatment guidelines propose various treatment approaches such as augmentation, combination and switching strategies for such patients with initial treatment failure. Among these treatment approaches, switching strategies are widely used in clinical practice. However, controlled clinical trials of the proper timing of antidepressant switch have not been adequately evaluated yet. The authors of the article under evaluation have investigated whether an early switch strategy should result in shorter times to response and remission in patients with initial treatment failure. They found that a higher remission rate was seen with the early switch strategy than conventional switch strategies. This article will discuss the clinical significance, related practical issues, potential limitations and future research implications based on findings from the original study.