Table 45-4 Clinical trials of switching strategies in unipolar depression

Table 45-4 Clinical trials of switching strategies in unipolar depression
Investigators	Failed antidepressant	Switch drug	N	Design	Daily dosage	Response rate
MAOIs
McGrath et al. 1987	Imipramine or phenelzine	Imipramine or phenelzine	101	RCT; c/o	60-90 mg phenelzine; 200-300 mg imipramine	17 of 26 (65%) phenelzine; 4 of 14 (29%) imipramine
Nolen et al. 1988b	TCA	Tranylcypromine	47	RCT	20-100 mg	13 of 25 (52%)
Thase et al. 1992	Imipramine	Tranylcypromine or phenelzine	42	Open	20-60 mg tranylcypromine; 30-90 mg phenelzine	23 of 42 (55%) MAOI
SSRIs
Delgado et al. 1988	TCA	Fluvoxamine	28	Open	100-300 mg	8 of 28 (29%)
Nolen et al. 1988a	TCA	Fluvoxamine or oxaprotiline	71	Double-blind partial c/o	100-300 mg fluvoxamine; 100-300 mg oxaprotiline	10% fluvoxamine; 39% oxaprotiline
Beasley et al. 1990	TCA	Fluoxetine	132	Open	Up to 300 mg TCA; up to 80 mg fluoxetine	51%-62% (varied by definition of treatment response)
White et al. 1990	Desipramine	Fluvoxamine	11	Open	50-300 mg	9 of 11 (82%)
Kocsis et al. 1995	Imipramine or sertraline	Sertraline or imipramine	62	RCT; c/o	Up to 300 mg imipramine; up to 200 mg sertraline	15 of 24 (63%) sertraline; 18 of 38 (47%) imipramine
Other antidepressants
Stern et al. 1983	TCA	Bupropion	33	Open	150-600 mg	62% of nonresponders
Nierenberg et al. 1994	Three or more prior adequate trials	Venlafaxine	84	Open	150-450 mg	30%-33%
Thase et al. 1998	SSRI	Nefazodone	115	Open	300-600 mg	66% of nonresponders
Catterson and Preskorn 1996	Amitriptyline	Mirtazapine	49	RCT; c/o	15-45 mg	59% of nonresponders
M. Fava et al. 1999	SSRI	Mirtazapine	103	Open	15-45 mg	47%
M. Fava et al. 2000c	Fluoxetine	Reboxetine	80	Open	8-10 mg	Significant improvement overall
Naturally occurring compounds
Takahashi et al. 1975	TCA	L-5-HTP	16	Open	300 mg	6 of 16 (38%)
Nolen et al. 1988b	TCA	L-5-HTP	12	Open	60-100 mg	0 of 12 (0%)
Rosenbaum et al. 1990	More than one prior adequate trial	SAMe	9	Open	400-1,600 mg	2 of 9 (22%)
Anticonvulsants and steroid-suppressing agents
Prasad 1985	Standard antidepressants	Carbamazepine	12	Open	400-600 mg	11 of 12 (92%)
Post et al. 1986	Unspecified antidepressants	Carbamazepine	11	RCT	400-2,000 mg	5 of 11 (45%)
Murphy et al. 1991	Standard antidepressants	Steroid suppressors (aminoglutethimide, metyrapone, and ketoconazole)	8	Open	500-1,000 mg aminoglutethimide; 500-2,000 mg metyrapone; 600-1,200 mg ketoconazole	6 of 8 (75%)
Note. MAOI = monoamine oxidase inhibitor; TCA = tricyclic antidepressant; SSRI = selective serotonin reuptake inhibitor; L-5-HTP = L-5-hydroxytryptophan; SAMe = S-adenosyl-L-methionine; RCT = randomized clinical trial; c/o = crossover.

Table 45-4 Clinical trials of switching strategies in unipolar depression
Investigators	Failed antidepressant	Switch drug	N	Design	Daily dosage	Response rate
MAOIs
McGrath et al. 1987	Imipramine or phenelzine	Imipramine or phenelzine	101	RCT; c/o	60-90 mg phenelzine; 200-300 mg imipramine	17 of 26 (65%) phenelzine; 4 of 14 (29%) imipramine
Nolen et al. 1988b	TCA	Tranylcypromine	47	RCT	20-100 mg	13 of 25 (52%)
Thase et al. 1992	Imipramine	Tranylcypromine or phenelzine	42	Open	20-60 mg tranylcypromine; 30-90 mg phenelzine	23 of 42 (55%) MAOI
SSRIs
Delgado et al. 1988	TCA	Fluvoxamine	28	Open	100-300 mg	8 of 28 (29%)
Nolen et al. 1988a	TCA	Fluvoxamine or oxaprotiline	71	Double-blind partial c/o	100-300 mg fluvoxamine; 100-300 mg oxaprotiline	10% fluvoxamine; 39% oxaprotiline
Beasley et al. 1990	TCA	Fluoxetine	132	Open	Up to 300 mg TCA; up to 80 mg fluoxetine	51%-62% (varied by definition of treatment response)
White et al. 1990	Desipramine	Fluvoxamine	11	Open	50-300 mg	9 of 11 (82%)
Kocsis et al. 1995	Imipramine or sertraline	Sertraline or imipramine	62	RCT; c/o	Up to 300 mg imipramine; up to 200 mg sertraline	15 of 24 (63%) sertraline; 18 of 38 (47%) imipramine
Other antidepressants
Stern et al. 1983	TCA	Bupropion	33	Open	150-600 mg	62% of nonresponders
Nierenberg et al. 1994	Three or more prior adequate trials	Venlafaxine	84	Open	150-450 mg	30%-33%
Thase et al. 1998	SSRI	Nefazodone	115	Open	300-600 mg	66% of nonresponders
Catterson and Preskorn 1996	Amitriptyline	Mirtazapine	49	RCT; c/o	15-45 mg	59% of nonresponders
M. Fava et al. 1999	SSRI	Mirtazapine	103	Open	15-45 mg	47%
M. Fava et al. 2000c	Fluoxetine	Reboxetine	80	Open	8-10 mg	Significant improvement overall
Naturally occurring compounds
Takahashi et al. 1975	TCA	L-5-HTP	16	Open	300 mg	6 of 16 (38%)
Nolen et al. 1988b	TCA	L-5-HTP	12	Open	60-100 mg	0 of 12 (0%)
Rosenbaum et al. 1990	More than one prior adequate trial	SAMe	9	Open	400-1,600 mg	2 of 9 (22%)
Anticonvulsants and steroid-suppressing agents
Prasad 1985	Standard antidepressants	Carbamazepine	12	Open	400-600 mg	11 of 12 (92%)
Post et al. 1986	Unspecified antidepressants	Carbamazepine	11	RCT	400-2,000 mg	5 of 11 (45%)
Murphy et al. 1991	Standard antidepressants	Steroid suppressors (aminoglutethimide, metyrapone, and ketoconazole)	8	Open	500-1,000 mg aminoglutethimide; 500-2,000 mg metyrapone; 600-1,200 mg ketoconazole	6 of 8 (75%)
Note. MAOI = monoamine oxidase inhibitor; TCA = tricyclic antidepressant; SSRI = selective serotonin reuptake inhibitor; L-5-HTP = L-5-hydroxytryptophan; SAMe = S-adenosyl-L-methionine; RCT = randomized clinical trial; c/o = crossover.