Switching Drug Class After Initial SSRI Failure

Letter to the Editor

Sir: The report by Joffe et al. underscores an important issue
for the practicing psychiatrist, namely, the appropriate next
step for the nonresponder to a serotonin selective reuptake inhibitor
(SSRI) antidepressant. Their data from an open-label,
non-placebo-controlled database review showed that 51% of
patients responded to a second SSRI after experiencing lack of
efficacy with their initial SSRI. This response represents an important
question to be assessed in controlled trials, and the authors
acknowledge that the lack of a placebo-controlled design
limits their conclusions.