MIDAS Project Publication Abstracts
Posternak, M.A., Zimmerman, M. Switching versus augmentation: A
prospective, naturalistic comparison in depressed, treatment- resistant
patients. Journal of Clinical Psychiatry, 2005, 62, 135-142.
Objectives: 1). To directly compare the effectiveness of switching
antidepressants with augmentation in depressed patients who do not respond
to an initial adequate trial, and 2). To determine whether there is a
decreased likelihood of responding to a second switch or augmentation
trial in those patients who did not respond to the first
treatment-resistant intervention. Method: In a naturalistic,
open-label design, prospective assessments were made on all depressed
outpatients who were treatment-resistant. Short- and long-term outcomes of
switching versus augmentation were compared using the Clinical Global
Impression scale. Results: In the acute phase, 37 of 74 (50.0%)
subjects responded to one of the two treatment-resistant interventions.
Forty-five percent and 56% of the patients who had their antidepressant
switched or augmented, respectively, responded to that intervention.
Nearly three-quarters (71.4%) of the acute responders maintained their
response through 6 months of follow-up. In 18 patients who did not respond
to the first switch or augmentation, 9 (50.0%) responded to a second
treatment-resistant trial. Conclusion: Switching antidepressants
was somewhat less effective than augmentation, though this difference was
not statistically significant. For patients who do not respond to an
augmentation or switch, our results suggest that a second
treatment-resistant trial may be just as effective.
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