Efficacy and tolerance of a medication switch from Escitalopram to Venlafaxine in patients with Major Depressive Disorders

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.