@article{ref1,
title="Non response at week 4 as clinically useful indicator for antidepressant combination in major depressive disorder. A sequential RCT",
journal="Journal of psychiatric research",
year="2017",
author="Kato, Masaki and Takekita, Yoshiteru and Koshikawa, Yosuke and Sakai, Shiho and Bandou, Hiroki and Nishida, Keiichiro and Sunada, Naotaka and Onohara, Ai and Hatashita, Yoshiyuki and Serretti, Alessandro and Kinoshita, Toshihiko",
volume="89",
number="",
pages="97-104",
abstract="We aimed to compare the efficacy and tolerability of mirtazapine versus SSRIs and to assess whether &quot;non-response at week 4&quot; may be a clinical indicator for combining mirtazapine and SSRIs for subsequent treatment. One-hundred fifty-four outpatients with MDD were randomized to receive mirtazapine or SSRIs in step I (4 weeks). Non-responders in step I were randomly assigned to either mirtazapine or SSRIs monotherapy or their combination in step IIa while responders in step I continued the same monotherapy in step IIb for 4 weeks. In step I, mirtazapine showed significantly faster improvement as shown by higher remission rate at week 2 with NNT = 8 compared to SSRIs. Somnolence rate was higher in mirtazapine and nausea rate was higher in SSRIs. In step IIa, combination therapy showed a more favorable time course than SSRIs monotherapy. For subjects taking SSRIs in step I, combination therapy showed significant better improvement in the Hamilton Depression Rating (HAM-D) score both at week 6 (p = 0.006) and 8 (p = 0.013) than SSRIs monotherapy. About 80% of responders at week 4 could reach remission at week 8 and 64% of non-responders could not reach remission at week 8 for patients who continued monotherapy. When mirtazapine was added on for SSRIs non-responders at week 4, the remission rate increased by 5% and HAM-D score improved by 4 points. While for mirtazapine non-responders, SSRIs add-on was not equally effective. Mirtazapine may provide a faster improvement and &quot;non-response at week 4&quot; may be indicator to mirtazapine add-on for patients receiving SSRIs.<br><br>Copyright © 2017 Elsevier Ltd. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="0022-3956",
doi="10.1016/j.jpsychires.2017.02.003",
url="http://dx.doi.org/10.1016/j.jpsychires.2017.02.003"
}