The use of antidepressant drugs for the treatment of MDD is well established. However,
a large proportion of individuals with depression do not respond to the first antidepressant,
requiring a modification of antidepressant medication. The switch of a selective serotonin
reuptake inhibitor (SSRI) like Escitalopram to a selective serotonin and noradrenaline
reuptake inhibitor (SSNRI) like Venlafaxine is frequently used in clinical routine,
however, only little is known about efficacy and tolerance of this switch. The current
study investigated the efficacy and tolerance of a medication switch from Escitalopram
to Venlafaxine after non-response of the depressive symptomatology (decrease of depression
severity < 50%) after 4 weeks of treatment with Escitalopram. 113 patients with MDD
were treated with Escitalopram for 4 weeks followed by a treatment with a stable dose
of Venlafaxine (225 to 375 mg/d) for another 4 weeks. We found that depression severity
significantly decreased after medication switch. Regarding tolerance, the results
showed that vertigo, hypoptyalism, hidrosis and obstipation re-occurred after the
switch from Escitalopram to Venlafaxine. The most frequent side effects during the
treatment with Venlafaxine were hidrosis and hypoptyalism. The majority of side effects
regressed spontaneously during the 4 weeks of treatment with venlafaxine. Our study
provides important information on the efficacy and tolerance of a frequently used
strategy in the treatment of MDD in clinical routine and provides the basis for an
informed consent with the patients.
This study was supported by Bundesministerium für Bildung und Forschung.
