Abstract：
BACKGROUND:Two broad treatment options exist for switching antidepressants for depressed patients who fail to respond to a selective serotonin reuptake inhibitor (SSRI): either a second course of SSRI therapy or a different class of antidepressants. The goal of the present work was to conduct a meta-analysis of studies comparing these two switch strategies. METHODS:Several sources were searched for randomized clinical trials comparing these two switch strategies. RESULTS:Data from four clinical trials (n = 1496) were combined using a random-effects model. Patients randomized to switch to a non-SSRI antidepressant (bupropion, mirtazapine, venlafaxine) were more likely to experience remission than patients switched to a second SSRI (risk ratio = 1.29, p = .007). Pooled remission rates were 28% (for non-SSRIs) and 23.5% (for SSRIs). There was also a nonsignificant trend (p = .1) in the rate of discontinuation due to intolerance favoring the within-class switch strategy (risk ratio = 1.23). There was no difference in response rates between the two treatment groups. CONCLUSIONS:These results suggest a modest yet statistically significant advantage in remission rates when switching patients with SSRI-resistant depression to a non-SSRI rather than an SSRI antidepressant. With the number needed to treat (NNT) statistic as one indicator of clinical significance, nearly 22 SSRI nonresponders would need to be switched to a non-SSRI rather than a second SSRI antidepressant to obtain one additional remitter. This difference falls well below the mark of NNT = 10 suggested by the United Kingdom's National Institute of Clinical Excellence but nonetheless might be of public health relevance given the large number of SSRI-resistant patients switched to an SSRI versus a non-SSRI antidepressant.
journal_name
Biol Psychiatryjournal_title
Biological psychiatryauthors
Papakostas GI,Fava M,Thase MEdoi
10.1016/j.biopsych.2007.08.010subject
Has Abstractpub_date
2008-04-01 00:00:00pages
699-704issue
7eissn
0006-3223issn
1873-2402pii
S0006-3223(07)00817-7journal_volume
63pub_type
杂志文章,meta分析abstract：BACKGROUND:Anterior cingulate cortex has been implicated in the pathogenesis of major depressive disorder (MDD). With single voxel proton magnetic resonance spectroscopy, we reported reductions in anterior cingulate glutamatergic concentrations (grouped value of glutamate and glutamine) in 14 pediatric MDD patients ver...
journal_title：Biological psychiatry
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journal_title：Biological psychiatry
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abstract：BACKGROUND:To determine the effects of depressive symptom severity on the circulating soluble adhesion molecule response to an acute exercise challenge in patients with heart failure (HF) compared with control subjects. METHODS:Thirty-eight male HF patients and 19 male control subjects (mean age +/- SEM: 55.5 +/- 1.9)...
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更新日期：2009-05-01 00:00:00
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journal_title：Biological psychiatry
pub_type： 杂志文章
doi：
更新日期：1983-05-01 00:00:00
abstract：:Tricyclic antidepressants are thought to act primarily via effects on adrenergic neurotransmitters. Recent research supports the concept that a major function of the central adrenergic system is the modulation of cerebral fluid dynamics. Based on this concept, studies in the rat were conducted to assess the effects of...
journal_title：Biological psychiatry
pub_type： 杂志文章
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更新日期：1979-04-01 00:00:00
abstract：:As many patients still require maintenance neuroleptic medication, it is important to determine what factors affect the course of tardive dyskinesia (TD) during ongoing neuroleptic treatment. In this study the data are from a series of annual examinations using the Abnormal Involuntary Movement Scale (AIMS) in a cohor...
journal_title：Biological psychiatry
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abstract：BACKGROUND:Identifying trait markers specific to schizophrenia might uncover mechanisms underlying illness susceptibility. Previous research shows the N2 and P3 event-related potentials are abnormal in schizophrenia; specificity of these potential trait markers has not been well established. METHODS:Electroencephalogr...
journal_title：Biological psychiatry
pub_type： 杂志文章,多中心研究
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abstract：BACKGROUND:Prior neurophysiological studies on patients with premenstrual syndrome (PMS) have revealed sleep electroencephalographic alterations in both cycle phases. We report on a study evaluating saccadic eye movements in PMS patients. METHODS:Saccadic eye movements were examined in 21 women with and 21 women witho...
journal_title：Biological psychiatry
pub_type： 临床试验,杂志文章
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abstract：BACKGROUND:Considering that platelets have been established to be good peripheral markers for the study of catecholaminergic neurons, we have applied an assay to measure the uptake of (3H)-dopamine (DA) into platelet storage granules (PSG). Recently, we reported that Tourette's syndrome (TS) patients (pts) show decreas...
journal_title：Biological psychiatry
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doi：10.1016/s0006-3223(01)01147-7
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journal_title：Biological psychiatry
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doi：10.1016/j.biopsych.2004.05.011
更新日期：2004-08-01 00:00:00
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journal_title：Biological psychiatry
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doi：10.1016/s0006-3223(03)00525-0
更新日期：2003-11-15 00:00:00
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journal_title：Biological psychiatry
pub_type： 杂志文章
doi：10.1016/0006-3223(87)90113-2
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journal_title：Biological psychiatry
pub_type： 杂志文章
doi：10.1016/0006-3223(93)90293-m
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journal_title：Biological psychiatry
pub_type： 杂志文章
doi：10.1016/j.biopsych.2004.09.016
更新日期：2004-12-15 00:00:00
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journal_title：Biological psychiatry
pub_type： 杂志文章
doi：10.1016/0006-3223(90)90007-o
更新日期：1990-02-01 00:00:00
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pub_type： 杂志文章
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更新日期：2009-10-15 00:00:00
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journal_title：Biological psychiatry
pub_type： 杂志文章
doi：10.1016/j.biopsych.2015.05.020
更新日期：2016-06-01 00:00:00
abstract：BACKGROUND:Shared neuropathological characteristics of patients with schizophrenia and their siblings might represent intermediate phenotypes that could be used to investigate genetic susceptibility to the illness. We sought to discover previously unidentified gray matter volume differences in patients with schizophren...
journal_title：Biological psychiatry
pub_type： 杂志文章
doi：10.1016/j.biopsych.2007.05.027
更新日期：2008-03-01 00:00:00
abstract：:The authors present a case report of neuroleptic malignant syndrome (NMS) in a patient commencing treatment with fluoxetine alone who had previously been treated with several antipsychotic and antidepressant combinations. On reviewing the literature on the pathogenesis of NMS, the authors hypothesize a facilitative ro...
journal_title：Biological psychiatry
pub_type： 杂志文章
doi：10.1016/0006-3223(90)90485-k
更新日期：1990-09-15 00:00:00
abstract：BACKGROUND:Association analysis identified the homeobox transcription factor, ENGRAILED 2 (EN2), as a possible autism spectrum disorder (ASD) susceptibility gene (ASD [MIM 608636]; EN2 [MIM 131310]). The common alleles (underlined) of two intronic single nucleotide polymorphisms (SNPs), rs1861972 (A/G) and rs1861973 (C...
journal_title：Biological psychiatry
pub_type： 杂志文章
doi：10.1016/j.biopsych.2009.05.027
更新日期：2009-11-15 00:00:00
abstract：:The involvement of the dopamine (DA) innervation of the medial prefrontal cortex (PFC) in attention was studied in a latent inhibition (LI) paradigm in rats. LI becomes evident by a retardation of conditioning to a stimulus after nonreinforced preexposure to that stimulus. LI is thought to reflect an animal's ability ...
journal_title：Biological psychiatry
pub_type： 杂志文章
doi：10.1016/S0006-3223(95)00595-1
更新日期：1996-12-01 00:00:00
abstract：BACKGROUND:Effects of the hypothalamic-pituitary-adrenal (HPA) axis on central dopaminergic systems have been proposed to underlie the development of psychotic symptoms in depression. This study examined HPA axis hormone effects on plasma levels of homovanillic acid (HVA), the dopamine metabolite, in healthy volunteers...
journal_title：Biological psychiatry
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1016/s0006-3223(97)00550-7
更新日期：1999-01-15 00:00:00
