Table 12.

Factors to Consider in Choosing between Switching to Another Antidepressant Monotherapy or Adding an Adjunctive Medication (Level 3 Evidence).

Consider switching to another antidepressant when: It is the first antidepressant trial. There are poorly tolerated side effects to the initial antidepressant. There is no response (<25% improvement) to the initial antidepressant.a There is more time to wait for a response (less severe, less functional impairment). Patient prefers to switch to another antidepressant.

Consider an adjunctive medication when: There have been 2 or more antidepressant trials. The initial antidepressant is well tolerated. There is partial response (>25% improvement) to the initial antidepressant. There are specific residual symptoms or side effects to the initial antidepressant that can be targeted. There is less time to wait for a response (more severe, more functional impairment). Patient prefers to add on another medication.

^aFor the initial antidepressant trial. In subsequent trials, lack of response (<25% improvement) may not be a factor for choosing between switch and adjunctive strategies.