The effectiveness of switching antidepressants during remission: a case series of depressed patients who experienced intolerable side effects

Background: It is unknown whether depressed patients who have experienced intolerable side effects to one antidepressant can safely and effectively be switched to a second antidepressant while the depressive disorder is in remission. The present study sought to determine the viability of such a strategy. Methods: All subjects were psychiatric outpatients who were treated in an open-label manner according to standard clinical practice. From an initial cohort of approximately 200 patients with major depressive disorder, 9 had their antidepressant switched while in remission because of intolerable side effects. Their subsequent course was prospectively assessed at each follow-up visit using Standardized Clinical Outcome Ratings and the Clinical Global Impression-Improvement scale. Results: Patients were prospectively followed for 8 to 110 weeks (median, 30 weeks) subsequent to the initiation of the second antidepressant trial. Switching antidepressants effectively eliminated the problematic side effects in all 9 cases. No relapses occurred during the second antidepressant trial. Conclusion: The present study provides preliminary evidence that switching antidepressants while in remission may be a safe and effective strategy for managing antidepressant-induced side effects. Limitations: Our findings are limited by the small sample size, lack of control group, and short follow-up periods in some cases.