A new study reviews the frequency and severity of side effects associated with a change, or addition of, an antidepressant medication.
Investigators embarked on the study amid concern that the relatively common practice of switching antidepressants, or adding a second antidepressant to the one an individual is already taking, may result in increased side effects.
Many clinicians weigh the possibility of adverse side effects when deciding between strategies. New research in the latest issue of General Hospital Psychiatry now suggests one strategy may not be any more likely to be harmful than the other.
More than 16 percent of U.S. adults are diagnosed with depression at some point during their lives and antidepressants are commonly used to treat them, according to a 2005 study in the Archives of General Psychiatry.
Unfortunately, knowing which antidepressant to prescribe is often a best educated guess, as research in both the American Journal of Psychiatry (2006) and the Annals of Internal Medicine (2008) determined that only 30 to 50 percent benefit from initial antidepressant treatment.
Another approach is to add a new antidepressant while continuing to take the original one, an approach known as augmenting, or switching to a new antidepressant.
Antidepressant medication side effects include headaches, difficulty sleeping and sexual dysfunction.
Experts previously assumed that either changing or adding a second medication might exacerbate these effects. However, in the current study, researchers unexpectedly found only minimal differences in the adverse side effects resulting from either strategy.
“We believed the augment group would have more side effects than the switch group,” said study author Richard Hansen, Ph.D., head of the department of pharmacy care systems at Auburn University.
In the study, nearly 1,300 patients who had not been successfully treated with just the antidepressant citalopram were divided into two groups.
One group had their citalopram augmented with bupropion or buspirone. The second group was switched to bupropion, sertraline or venlafaxine. Patients were followed for about five visits over 14 weeks to evaluate what, if any, side effects occurred.
The researchers found that although painful urination and problems with sexual dysfunction were more common in the augment group than the switched group, the differences were not statistically significant.
“For treatment-resistant depression, the decision to augment or switch medications should be based on individual patient’s clinical status, as well as the possible benefits and risks of each treatment,” Hansen told the Health Behavior News Service.
Alan Schmetzer, M.D., interim chairman of the department of psychiatry at Indiana University School of Medicine in Indianapolis, agreed and said the likelihood of his patients responding to the first medication at the first dose he prescribes is around 40 to 50 percent.
“This study tries to answer an important question to which there is currently no research available,” said Schmetzer.
“It’s worthwhile because if we knew it was harder on patients to do the augmentation strategy, then we would first try switching all of the time.”
Source: Health Behavior News Service