After the failure of a 1st antidepressant, the 2nd choices are not all equal

“But only one out of two patients benefits from the first prescribed antidepressant treatment.»

“Several drug strategies are used in the event of failure of this first treatment, the most frequent being to prescribe another antidepressant instead of, or in addition to the first.However, there is no consensus on the best second-line options.

To identify these options, Cédric Lemogne and his colleagues (1) Hôtel-Dieu AP-HP hospital, Inserm and Paris Cité University analyzed data from the National Health Data System (SNDS) covering more than 80% of the French population and those from the Caisse National Health Insurance (Cnam).

They identified 1.2 million people who received an antidepressant for the first time in 2011, of whom more than 63,000 subsequently received a second. The 2nd antidepressant was considered to have been deemed acceptable when the prescription had been renewed at least twice.

The results show that:

Furthermore :

• The most effective second-line option was almost always escitalopram (Seroplex, Lexapro, Cipralex), while venlafaxine (Effexor) was the most effective second-line option after treatment with escitalopram, followed by sertraline ( Zoloft) and fluoxetine (Prozac).

• Some second-line treatments have proven to be significantly less effective than the reference option. For example, after first-line treatment with venlafaxine (Effexor), second-line treatment with tianeptine (Stablon) or mianserin, although prescribed as much as sertraline (Zoloft), was half as effective.

“This study suggests that not all second-line antidepressant treatments are created equal and should be chosen based on the first antidepressant prescribed“, conclude the researchers.

“Also, this study paves the way for the use of medico-administrative databases such as the SDNS in the evaluation, not only of the efficiency of antidepressant treatments, but also of other drugs, both in their primary indication. only as candidates for repositioning.»

For more information on treating depression, see the links below.

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

Psychomedia with sources: APHP, Journal of Clinical Psychiatry.
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