Switching treatments for complicated depression.

The majority of depressed patients will not experience remission when treated with a first-line antidepressant. As a next-step strategy for patients who achieve partial response to the initial antidepressant, clinicians may opt to augment the first antidepressant with another medication or combine it with a second antidepressant. For nonresponders or for patients experiencing intolerable side effects, clinicians may choose to switch medications. Switching can be done within the same drug class to obtain different pharmacologic properties, or to another class to obtain a different neurochemical effect. Switching appears to be fairly well tolerated and effective for patients with treatment-resistant depression, but should be tailored to the individual patient's needs and preferences.