Partial Response, Nonresponse, and Relapse With Selective Serotonin Reuptake Inhibitors in Major Depression: A Survey of Current "Next-Step" Practices

Background: Many patients treated for majordepression require more than one antidepressant trial to achieveor sustain response. However, the literature provides fewtreatment algorithms or effectiveness studies that empiricallysupport “next-step” options available to clinicians. Weconducted a survey of psychiatrists and other medical specialistswho treat depression to ascertain what clinicians actually dowhen faced with patients who suboptimally respond to an adequatecourse of selective serotonin reuptake inhibitor (SSRI) therapy.

Method: Attendees at a psychopharmacology course(N = 801) were queried about their top choices forantidepressant-treatment nonresponders: a minimal responder after4 weeks of adequate SSRI treatment, a partial responder after 8weeks of adequate SSRI therapy, a nonresponder after 8 weeks ofadequate SSRI therapy, and a relapser on long-term SSRImaintenance therapy. Choices included raising the dose,augmenting or combining with another agent, switching to a secondSSRI, or switching to a non-SSRI agent.

Results: 432 (54%) of the surveys were returned.Raising the dose was the most frequently reported next-stepstrategy for a patient with minimal response after 4 weeks ofadequate SSRI therapy, partial response after 8 weeks of adequateSSRI therapy, and relapse on long-term SSRI therapy. Switching toa non-SSRI agent was the most frequently chosen option fornonresponders to an adequate trial of SSRI therapy.

Conclusion: Our findings suggest that cliniciansselect different next-step strategies when patients arenonresponders versus when patients are partial responders orrelapsers.