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After SSRI Fails, Switching Antidepressants May Help

STAR*D study results suggest that about one in four patients may benefit from switch

FRIDAY, March 24 (HealthDay News) -- A proportion of patients with major depression who are unresponsive to the selective serotonin-reuptake inhibitor citalopram may benefit from taking an alternate antidepressant, according to two studies reporting results from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial in the March 23 issue of the New England Journal of Medicine.

A. John Rush, M.D., from the University of Texas Southwestern Medical Center, and members of the STAR*D study team randomly assigned 727 citalopram-unresponsive patients to up to 14 weeks of either sustained-release bupropion, sertraline, or extended-release venlafaxine. About one in four patients had a remission of symptoms after switching, with no particular drug proving more effective.

In the second study, the STAR*D team led by Madhukar H. Trivedi, M.D., also at UT Southwestern, found that augmenting citalopram with either sustained-release bupropion or buspirone resulted in about a 30 percent remission rate in 565 citalopram-unresponsive depressed adults, with bupropion having some advantage over buspirone.

In an editorial, David R. Rubinow, M.D., from the University of North Carolina at Chapel Hill, writes that these two studies are both "illuminating and disconcerting." While they provide real-world data that alternative therapies may help those unresponsive to citalopram, at least half will not have remission.

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