Antidepressant Dosing and Switching Guidelines: Focus on Nefazodone

Dosing strategies form a fulcrum between patient-related and provider-related dimensions of treatment. The former focus on perceptions of efficacy and safety and adherence to the regimen, whereas the latter focus on symptom identification and appropriate drug selection. Appropriate dosing strategies may modulate adverse effects, allowing the patient to move more comfortably toward an efficacious response. Dosing also is an important dimension in switching between 2 antidepressants when the efficacy of the first agent is suboptimal. Nefazodone is effective for the management of acute, severe, and chronic major depression and relapse prevention. Response rates with nefazodone are comparable to those of imipramine and most SSRIs. In clinical trials, the efficacy of nefazodone was most clearly established at doses between 300 and 600 mg/day. At this dose range, discontinuations because of adverse events are low.