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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)
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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 

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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.

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