Switching antidepressants in patients with treatment-resistant depression

editorial reviewed“Switching” antidepressant consists in switching from an ineffective antidepressant to a new antidepressant from a similar or different mechanism of action. It is one of the most recommended second step options in treatment-resistant depression (TRD). The possibility of changing treatment following treatment failure is not limited to the issue of choosing which antidepressant will be prescribed in a further step. This strategy is much more complex and needs to consider a variety of factors relating to how to achieve this change in treatment. During a depressive episode that does not respond sufficiently to treatment, this phase is often painful for the patient and complicated for the clinician. On the one hand, it is necessary to make the difficult choice of another antidepressant, but also to reevaluate the clinical situation and to plan how to implement the change in the safest and most effective way. In this chapter, we address these issues from a clinical perspective, focusing on key elements of the switching strategy in TRD: implication in the definition of TRD, choice of second step treatment, and how to implement the treatment switch