After the failure of a 1st antidepressant, the 2nd selections aren’t all equal

After the failure of a 1st antidepressant, the 2nd selections aren’t all equal

However just one out of two sufferers advantages from the primary prescribed antidepressant remedy.»

A number of drug methods are used within the occasion of failure of this primary remedy, essentially the most frequent being to prescribe one other antidepressant as a substitute of, or along with the primary.Nonetheless, there isn’t a consensus on the most effective second-line choices.

To determine these choices, Cédric Lemogne and his colleagues (1) Hôtel-Dieu AP-HP hospital, Inserm and Paris Cité College analyzed information from the Nationwide Well being Knowledge System (SNDS) masking greater than 80% of the French inhabitants and people from the Caisse Nationwide Well being Insurance coverage (Cnam).

They recognized 1.2 million individuals who obtained an antidepressant for the primary time in 2011, of whom greater than 63,000 subsequently obtained a second. The 2nd antidepressant was thought-about to have been deemed acceptable when the prescription had been renewed a minimum of twice.

The outcomes present that:

Moreover :

  • The best second-line possibility was nearly at all times escitalopram (Seroplex, Lexapro, Cipralex), whereas venlafaxine (Effexor) was the best second-line possibility after remedy with escitalopram, adopted by sertraline ( Zoloft) and fluoxetine (Prozac).

  • Some second-line therapies have confirmed to be considerably much less efficient than the reference possibility. For instance, after first-line remedy with venlafaxine (Effexor), second-line remedy with tianeptine (Stablon) or mianserin, though prescribed as a lot as sertraline (Zoloft), was half as efficient.

This examine means that not all second-line antidepressant therapies are created equal and needs to be chosen primarily based on the primary antidepressant prescribed“, conclude the researchers.

Additionally, this examine paves the best way for the usage of medico-administrative databases such because the SDNS within the analysis, not solely of the effectivity of antidepressant therapies, but in addition of different medicine, each of their major indication. solely as candidates for repositioning.»

For extra info on treating despair, see the hyperlinks beneath.

(1) Charles Ouazana-Vedrines, Thomas Lesuffleur, Pierre Denis, Nicolas Hoertel, Romain Olekhnovitch, Mark Olfson, Carlos Blanco, Frédéric Limosin, Antoine Rachas, Philippe Tuppin.

(2) These antidepressants are a part of the so-called particular serotonergic and noadrenergic antidepressants (ASNA). Mirtazapine (Remeron, Norset…) and mianserin belong to this class.

Psychomedia with sources: APHP, Journal of Scientific Psychiatry.
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