Evidence map›Paper›PMID 30698114›Full record

Trial reportThe British journal of psychiatry : the journal of mental science2019

Effect of antidepressant switching between nortriptyline and escitalopram after a failed first antidepressant treatment among patients with major depressive disorder.

Ole Köhler-Forsberg, Erik Roj Larsen, Henriette N Buttenschøn, Marcella Rietschel, Joanna Hauser, Daniel Souery, Wolfgang Maier, Anne Farmer, Peter McGuffin, Katherine J Aitchison and 2 more

Open access · bronzeAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The British journal of psychiatry : the journal of mental science, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
1.2field-weighted citation impact, top 23% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 11 citations in OpenAlex.

  1. Trial
  2. Article
  3. Precision Medicine in Antidepressants Treatment.Handbook of experimental pharmacology · 2023
    Review
  4. Antidepressant-like Activity of Patchouli Oil var. Tapak Tuan (Pharmaceuticals (Basel, Switzerland) · 2022
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors at 9 institutions in 6 countries.

Ole Köhler-ForsbergPsychosis Research Unit,Aarhus University Hospital - Psychiatry;Department of Clinical Medicine,Aarhus University;and iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research,Denmark.ORCID 0000-0001-5121-1287
Erik Roj LarsenChief Physician,Department of Psychiatry,Psychiatry in the Region of Southern Denmark,Institute of Clinical Research,Research Unit of Psychiatry,University of Southern Denmark,Denmark.
Henriette N ButtenschønAssociate Professor,iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research;and Translational Neuropsychiatry Unit,Department of Clinical Medicine,Aarhus University,Denmark.
Marcella RietschelProfessor,Central Institute of Mental Health,Department of Genetic Epidemiology in Psychiatry,Medical Faculty Mannheim/Heidelberg University,Germany.
Joanna HauserProfessor,Laboratory of Psychiatric Genetics,Department of Psychiatry,Poznan University of Medical Sciences,Poland.
Daniel SoueryProfessor,Laboratoire de Psychologie Médicale,Université Libre de Bruxelles;Psy Pluriel - Centre Européen de Psychologie Médicale,Belgium.
Wolfgang MaierProfessor,Department of Psychiatry,University of Bonn,Germany.
Anne FarmerProfessor,Social, Genetic and Developmental Psychiatry Centre,Institute of Psychiatry, Psychology and Neuroscience,King's College London,UK.
Peter McGuffinProfessor,Social, Genetic and Developmental Psychiatry Centre,Institute of Psychiatry, Psychology and Neuroscience,King's College London,UK.
Katherine J AitchisonProfessor,University of Alberta,Canada.
Rudolf UherProfessor,Social, Genetic and Developmental Psychiatry Centre,Institute of Psychiatry,Psychology and Neuroscience,King's College London,UK;and Department of Psychiatry,Dalhousie University,Canada.ORCID 0000-0002-2998-0546
Ole MorsProfessor,Psychosis Research Unit,Aarhus University Hospital - Psychiatry;Department of Clinical Medicine,Aarhus University;and iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research,Denmark.
Aarhus University · DKKing's College London · GBDalhousie University · CAHeidelberg University · DEPoznan University of Medical Sciences · PLUniversité Libre de Bruxelles · BEUniversity of Alberta · CAUniversity of Bonn · DEUniversity of Southern Denmark · DK

Funding

Medical Research Council G0600204
6 · The paper itself

Abstract

backgroundFor patients with major depressive disorder (MDD) experiencing side-effects or non-response to their first antidepressant, little is known regarding the effect of switching between a tricyclic antidepressant (TCA) and a selective serotonin reuptake inhibitor (SSRI).AimsTo compare the switch between the TCA nortriptyline and the SSRI escitalopram.

methodAmong 811 adults with MDD treated with nortriptyline or escitalopram for up to 12 weeks, 108 individuals switched from nortriptyline to escitalopram or vice versa because of side-effects or non-response (trial registration: EudraCT No.2004-001723-38 (https://eudract.ema.europa.eu/) and ISRCTN No.03693000 (http://www.controlled-trials.com)). Patients were followed for up to 26 weeks after switching and response was measured with the Montgomery-Åsberg Depression Rating scale (MADRS). We performed adjusted mixed-effects linear regression models with full information maximum likelihood estimation reporting β-coefficients with 95% CIs.

resultsSwitching antidepressants resulted in a significant decrease in MADRS scores. This was present for switchers from escitalopram to nortriptyline (n = 36, β = -0.38, 95% CI -0.51 to -0.25, P<0.001) and from nortriptyline to escitalopram (n = 72, β = -0.34, 95% CI -0.41 to -0.26, P<0.001). Both switching options resulted in significant improvement among individuals who switched because of non-response or side-effects. The results were supported by analyses on other rating scales and symptom dimensions.

conclusionsThese results suggest that switching from a TCA to an SSRI or vice versa after non-response or side-effects to the first antidepressant may be a viable approach to achieve response among patients with MDD.Declarations of interestK.J.A. holds an Alberta Centennial Addiction and Mental Health Research Chair, funded by the Government of Alberta. K.J.A. has been a member of various advisory boards, received consultancy fees and honoraria, and has received research grants from various companies including Johnson and Johnson Pharmaceuticals Research and Development and Bristol-Myers Squibb Pharmaceuticals Limited. D.S. has served on advisory boards for, and received unrestricted grants from, Lundbeck and AstraZeneca. A.F. and P.M. have received honoraria for participating in expert panels for Lundbeck and GlaxoSmithKline.

Indexed as

Drug SubstitutionAdultAntidepressive Agents, TricyclicCitalopramDrug UtilizationEuropeFemaleHumansLinear ModelsLogistic ModelsMajor Depressive DisorderMaleMiddle AgedNortriptylineSelective Serotonin Reuptake InhibitorsTreatment FailureAntidepressive Agents, TricyclicCitalopramNortriptylineSelective Serotonin Reuptake InhibitorsantidepressantsDepressionnon-respondersside-effectsswitching

Identifiers

PMID30698114
PMCPMC6624130
OpenAlexW2912922183

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.