Marangell L B
Department of Psychiatry, Baylor College of Medicine, Houston, Tex 77030, USA.
J Clin Psychiatry. 2001;62 Suppl 18:12-7.
A substantial proportion of patients suffering from major depression experience insufficient clinical response, despite appropriate treatment. Switching to a different monotherapy antidepressant medication is the preferred option for many patients and clinicians. The possible advantages of switching to a different monotherapy, as compared with adding a second agent (i.e., augmenting or combining), include reduced medication costs, fewer drug interactions, better adherence, and less patient burden over time. Response rates for switching, are based largely on open trials, which reveal a response rate of approximately 50%. These response rates are comparable to the response rates reported with augmentation or combination, again established largely by noncomparative open trials. This review article summarizes clinical considerations and available evidence regarding switching antidepressants in the treatment of major depression. Practical issues, such as when to consider switching and how to switch from one medication to another, are addressed.
尽管接受了适当的治疗，但仍有相当一部分重度抑郁症患者临床反应不足。对许多患者和临床医生来说，换用另一种单一疗法抗抑郁药物是首选方案。与添加第二种药物（即增效或联合用药）相比，换用另一种单一疗法的可能优势包括降低药物成本、减少药物相互作用、更好的依从性以及随着时间推移减轻患者负担。换药的有效率很大程度上基于开放试验，开放试验显示有效率约为50%。这些有效率与增效或联合用药所报告的有效率相当，同样也主要是由非对照开放试验确定的。这篇综述文章总结了在重度抑郁症治疗中换药的临床考量和现有证据。文中还讨论了一些实际问题，比如何时考虑换药以及如何从一种药物转换为另一种药物。
