Table 3.

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.

With permission from (Kennedy et al., 2016).

^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.