Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-17T01:26:18.295Z Has data issue: false hasContentIssue false
  • English
  • Français

How to switch to agomelatine after an unsuccessful try with paroxetine or venlafaxine

Published online by Cambridge University Press:  13 December 2013

Michel Lejoyeux ,
Sophie Matharan  and
Christian de Bodinat
Michel Lejoyeux*
Affiliation:
Hôpital Bichat, Claude Bernard 46, Paris, France
Sophie Matharan
Affiliation:
Institut de Recherches Internationales Servier (IRIS), Suresnes, France
Christian de Bodinat
Affiliation:
Institut de Recherches Internationales Servier (IRIS), Suresnes, France
*
*Address for correspondence: Michel Lejoyeux, Hôpital Bichat, Claude Bernard 46, rue Henri Huchard, 75018 Paris, France. (Email michel.lejoyeux@bch.aphp.fr)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective/introduction

The present trial informs clinicians about switching conditions with the antidepressant agomelatine after the failure of a treatment with either paroxetine or venlafaxine.

Methods

The total number of discontinuation-emergent symptoms, according to the Discontinuation-Emergent Signs and Symptoms checklist, was compared in double-blind conditions after 3 switching options: immediate substitution or initiation of agomelatine (25 mg/day p.o.) with either a short- or long-tapering of the previous drug. Secondary objectives included tolerability and safety assessments and the early clinical benefit after the switch.

Results

For all switching options, a withdrawal syndrome was observed 1 week after cessation of the selective serotonin reuptake inhibitor (SSRI)/serotonin–norepinephrine reuptake inhibitor (SNRI) treatment. Psychic symptoms were the most frequently reported, and somatic symptoms were comparatively few. Early discontinuation symptoms after cessation of SSRI/SNRI treatment did not prejudice the antidepressant benefits of agomelatine over 8 weeks.

Conclusions

Both abrupt and start–taper switching with agomelatine are options in everyday practice for those patients who have not responded to either paroxetine or venlafaxine. However, regardless of the switching strategy, the present double-blind study shows that early discontinuation symptoms that arise upon cessation of SSRI/SNRI can alter the patients’ perception of the clinical benefit of the new antidepressant. Both practitioners and patients must be warned about these early discontinuation symptoms to prevent the symptoms from being confounded with a lack of therapeutic benefit of the new treatment.

Keywords

AgomelatineDESSTapering
Type
Original Research
Information
CNS Spectrums , Volume 20 , Issue 1 , February 2015 , pp. 29 - 38
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

This work was completed on behalf of the Agomelatine Study Group: I. Reis de Oliveira, MD, PhD (Salvador, Brazil); R. Didi, MD (Dijon, France); M. Bauer, MD (Dresden, Germany); I. Bitter, MD (Budapest, Hungary); E. Lara, MD (Lisbon, Portugal); A. Siracusano, MD (Rome, Italy); J de la Gándara, MD (Burgos, Spain); Pierre-François Penelaud, MD (IRIS, Suresnes Cedex, France); Françoise Picarel-Blanchot PhD (IRIS, Suresnes Cedex, France) This article was presented at the 26th European College of Neuropsychopharmacology Congress, Barcelona.

Funding for this study was provided by Servier (Suresnes, France). The sponsor of the study participated in study design, data collection, data analysis, data interpretation, and writing of the report.

Trial registration name: Initiation of agomelatine after antidepressant treatment in outpatients suffering major depressive disorder. Trial registration number: ISRCTN97599615.

References

1. Stahl, SM. Enhancing outcomes from major depression: using antidepressant combination therapies with multifunctional pharmacologic mechanisms from the initiation of treatment. CNS Spectr. 2010; 15(2): 79–94.CrossRefGoogle ScholarPubMed
2. Connolly, KR, Thase, ME. If at first you don't succeed: a review of the evidence for antidepressant augmentation, combination and switching strategies. Drugs. 2011; 71(1): 43–64.CrossRefGoogle ScholarPubMed
3. Haddad, PM, Qureshi, M. Misdiagnosis of antidepressant discontinuation symptoms. Acta Psychiatr Scand. 2000; 102(6): 466–467.CrossRefGoogle ScholarPubMed
4. Anderson, IM, Nutt, DJ, Deakin, JF. Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 1993 British Association for Psychopharmacology guidelines. British Association for Psychopharmacology. J Psychopharmacol. 2000; 14(1): 3–20.CrossRefGoogle ScholarPubMed
5. Haddad, PM, Anderson, IM. Recognising and managing antidepressant discontinuation symptoms. Advances in Psychiatric Treatment. 2007; 13: 447–457.CrossRefGoogle Scholar
6. de Bodinat, C, Guardiola-Lemaitre, B, Mocaer, E, etal. Agomelatine, the first melatonergic antidepressant: discovery, characterization and development. Nat Rev Drug Discov. 2010; 9(8): 628–642.CrossRefGoogle ScholarPubMed
7. Rosenbaum, JF, Fava, M, Hoog, SL, Ascroft, RC, Krebs, WB. Selective serotonin reuptake inhibitor discontinuation syndrome: a randomized clinical trial. Biol Psychiatry. 1998; 44(2): 77–87.CrossRefGoogle ScholarPubMed
8. Sheehan, DV, Lecrubier, Y, Sheehan, KH, etal. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998; 59(Suppl 20): 22–33.Google ScholarPubMed
9. Zigmond, AS, Snaith, RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983; 67(6): 361–370.CrossRefGoogle ScholarPubMed
10. Guy, W, National Institute of Mental Health. CGI Clinical Global Impressions. In: ECDEU Assessment Manual for Psychopharmacology. 1976 ed. Rockville, MD: U.S. Dept. of Health, Education, and Welfare; Public Health Service; Alcohol, Drug Abuse, and Mental Health Administration; National Institute of Mental Health, Psychopharmacology Research Branch, Division of Extramural Research Programs; 1976:217–222.Google Scholar
11. Warner, CH, Bobo, W, Warner, C, Reid, S, Rachal, J. Antidepressant discontinuation syndrome. Am Fam Physician. 2006; 74(3): 449–456.Google ScholarPubMed
12. Tint, A, Haddad, PM, Anderson, IM. The effect of rate of antidepressant tapering on the incidence of discontinuation symptoms: a randomised study. J Psychopharmacol. 2008; 22(3): 330–332.Google ScholarPubMed
13. Dominguez, RA, Goodnick, PJ. Adverse events after the abrupt discontinuation of paroxetine. Pharmacotherapy. 1995; 15(6): 778–780.CrossRefGoogle ScholarPubMed
14. Fava, M, Mulroy, R, Alpert, J, Nierenberg, AA, Rosenbaum, JF. Emergence of adverse events following discontinuation of treatment with extended-release venlafaxine. Am J Psychiatry. 1997; 154(12): 1760–1762.CrossRefGoogle ScholarPubMed
15. Judge, R, Parry, MG, Quail, D, Jacobson, JG. Discontinuation symptoms: comparison of brief interruption in fluoxetine and paroxetine treatment. Int Clin Psychopharmacol. 2002; 17(5): 217–225.CrossRefGoogle ScholarPubMed
16. Michelson, D, Fava, M, Amsterdam, J, etal. Interruption of selective serotonin reuptake inhibitor treatment: double-blind, placebo-controlled trial. Br J Psychiatry. 2000; 176): 363–368.CrossRefGoogle ScholarPubMed
17. Lejoyeux, M, Ades, J. Antidepressant discontinuation: a review of the literature. J Clin Psychiatry. 1997; 58(Suppl 7): 11–15.Google ScholarPubMed
18. Montgomery, SA, Kennedy, SH, Burrows, GD, Lejoyeux, M, Hindmarch, I. Absence of discontinuation symptoms with agomelatine and occurrence of discontinuation symptoms with paroxetine: a randomized, double-blind, placebo-controlled discontinuation study. Int Clin Psychopharmacol. 2004; 19(5): 271–280.CrossRefGoogle ScholarPubMed
19. Price, JS, Waller, PC, Wood, SM, MacKay, AV. A comparison of the post-marketing safety of four selective serotonin re-uptake inhibitors including the investigation of symptoms occurring on withdrawal. Br J Clin Pharmacol. 1996; 42(6): 757–763.CrossRefGoogle ScholarPubMed
20. McAllister-Williams, RH, Baldwin, DS, Haddad, PM, Bazire, S. The use of antidepressants in clinical practice: focus on agomelatine. Hum Psychopharmacol. 2010; 25(2): 95–102.Google ScholarPubMed