Early versus conventional switching of antidepressant: a post-hoc analysis of clinical trial data for major depressive disorder with moderate to severe pain symptoms

Abstract

A number of different antidepressants, each with unique pharmacological profiles, are used for treatment of major depressive disorder (MDD); however, these drugs have been found in placebo-controlled, large practical clinical trials to have limited efficacy for achieving full recovery in MDD patients. In particular, when depressed patients have pain symptoms, their chance of remission is significantly decreased. Pain also often leads to residual symptoms and incomplete functional recovery. Hence, while pain should be a principal target symptom in patients with MDD, there continues to be unmet need for pain treatment in depressed patients. Therefore, more diverse options for treatment approaches can be expected to enhance outcomes in clinical treatment of depressed patients with comorbid pain. In this context, Dr. Romera and colleagues have investigated an early antidepressant-switching strategy in patients with initial treatment failure. They found that early switching to a different antidepressant in MDD patients with moderate-to-severe symptoms of physical pain seems to lead to better pain and functional outcomes. This article discusses clinical significance, practical issues, potential limitations, and future research implications based on the findings from Dr. Romera and colleagues' study.