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Background. Partial response, no response, or residual symptoms following antidepressant therapy is common in clinical psychiatry. This study evaluated modafinil in patients with major depressive disorder (MDD) who were partial responders to adequate selective serotonin reuptake inhibitor (SSRI) therapy and excessive sleepiness and fatigue. Methods. This retrospective analysis pooled the data of patients (18-65 yrs) who participated in two randomized, double-blind, placebo-controlled studies of modafinil (6-week, flexible-dose study of 100-400 mg/day or 8-week, fixed-dose study of 200 mg/day) plus SSRI therapy. Patients (n = 348) met criteria for several residual symptoms (Epworth Sleepiness Scale [ESS] score ≥10; 17-item Hamilton Depression Scale [HAM-D] score between 4 and 25; and Fatigue Severity Scale [FSS] score ≥4). Results. Compared to placebo, modafinil augmentation rapidly (within 1 week) and significantly improved overall clinical condition (Clinical Global Impression-Improvement), wakefulness (ESS), depressive symptoms (17-item HAM-D), and fatigue (FSS) (p < .01 for all). At final visit, patients receiving modafinil augmentation experienced statistically significant improvements in overall clinical condition, wakefulness, and depressive symptoms. Modafinil was well tolerated in combination with SSRI. Conclusions. Results of this pooled analysis provide further evidence suggesting that modafinil is an effective and well-tolerated augmentation therapy for partial responders to SSRI therapy, particularly when patients continue to experience fatigue and excessive sleepiness. [ABSTRACT FROM AUTHOR]

Background. This study compares the efficacy and tolerability of 12 weeks of open-label duloxetine in adult outpatients with anxious versus non-anxious depression. Methods. Participants in a major depressive episode (N = 249) began duloxetine treatment at 30 or 60 mg daily for the first week, followed by up to 11 weeks of flexibly dosed duloxetine (60, 90, or 120 mg daily). Efficacy measures included HAMD17, HAMA, and CGI-S. Safety and tolerability were assessed by early discontinuation and adverse event rates. Anxious depression was defined by a HAMD17 Anxiety/Somatization Factor score ≥ 7. Results. Duloxetine treatment was associated with a significantly greater reduction in total HAMD17 scores and HAMD17 Anxiety/Somatization Factor scores among patients with anxious depression compared to non-anxious depression. Differences in CGI-S and HAMA scores at the end of the trial between groups were not statistically significant. Remission and response rates at endpoint were similar between groups, but anxious depressives had a significantly shorter median time to response. Discontinuation rates due to any reason, discontinuation due to adverse events, and treatment-emergent adverse events were similar between groups, except for the significantly greater occurrence of influenza in anxious depressives. Conclusions. Duloxetine's efficacy in anxious depression was somewhat superior to non-anxious depression; tolerability was comparable between groups. [ABSTRACT FROM AUTHOR]

Depressive disorders are highly prevalent in the general population. Long-term treatment with antidepressants consolidates the improvement obtained during the acute phase of the treatment and prevents relapses and recurrences of the disorder. On the other hand, there is growing evidence that antidepressant side effects may limit patients' quality of life and social functioning, as well as affect patients' health and treatment adherence. Most studies concerning antidepressant treatment have focused on short-term tolerability, ignoring both early-onset persistent side effects and late-onset side effects that are reported during long-term treatment Nevertheless, these long-term treatment side effects are likely to have a dramatic impact on patient outcome and treatment adherence. Common long-term side effects of antidepressants are weight gain, sexual dysfunction, sleep disturbances, fatigue, apathy, and cognitive impairment (e.g., working memory dysfunction). Usual strategies for the management of these long-term side effects are: changing drug daily schedule, various augmentation therapies, antidepressant switches, drug- holidays, and dose tapering, with the latter two strategies being strongly discouraged on the basis of concerns that patients' depressive episodes may return. Selective serotonin reuptake inhibitors (SSRIs) and atypical antidepressants (e.g., venlafaxine, bupropion, and nefazodone) show a relatively favorable short-term as well as long-term tolerability compared with older drugs (e.g., tricyclics and monoamine oxidase inhibitors). Therefore, clinicians are likely to prefer them in usual practice, especially among patients requiring maintenance treatment The present review focuses on management of long-term side effects. [ABSTRACT FROM AUTHOR]

Background. Research studies have focused attention on the importance of the comorbidity of personality disorders and depression. Methods. The present review examines seven potential explanations for the overlap to clarify the nature of the relationship, if any, between depression and personality disorder diagnoses. Results. There may be many explanations for the potential overlap of personality disorders (PD) and major depressive disorder (MDD). For example, the distinction between states and traits may not be as clear and definitive as suggested in the DSM-IV. In some cases, depression may influence personality pathology, and may even lead to personality disorders. In other cases, personality disorders may lead to MDD. Conclusion. Further research may clarify the nature of the relationship, if any, between depression and personality disorder diagnoses, as well as the relationship between comorbidity and treatment response. [ABSTRACT FROM AUTHOR]

BACKGROUND: This study examined whether a culturally focused psychiatric consultation program (CFP) for Latino Americans was equally effective in reducing depressive symptoms in English-speaking and Spanish-speaking patients. METHODS: The CFP utilizes the Engagement Interview Protocol (EIP), a semi-standardized protocol eliciting patient narratives about illness beliefs. The sample included 118 Latino American patients presenting with depressive symptoms. Patient-preferred primary language was examined as a moderator for the effect of CFP participation vs usual care on change in depressive symptoms. RESULTS: Multiple regression analysis revealed that the interaction effect of primary language and treatment arm on depressive symptoms, as measured by the Quick Inventory of Depressive Symptomatology-Self Report was not statistically significant at 6-month follow-up (B = -2.89, t = -1.35, P = .180). CONCLUSIONS: The findings suggest that the CFP was equally effective in both Spanish and English-speaking Latino Americans. The trend in the results toward greater reduction in depressive symptoms in primary Spanish-speaking Latino Americans as compared with primary English-speaking Latino Americans suggests the importance of receiving language-concordant care. [ABSTRACT FROM AUTHOR]

BACKGROUND: In treated patients with major depressive disorder (MDD), residual symptoms are common and challenging to disentangle from possible antidepressant side effects. Our objective was to prospectively differentiate between rates of residual symptoms and treatment-emergent side effects. METHODS: Participants in an episode of MDD were enrolled in a 6-week trial of an antidepressant. Assessments occurred at baseline and after 6 weeks of treatment, using the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR) and the Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire (MGH CPFQ). Among treatment responders, residual symptoms were those that remained the same or improved. Side effects were defined as newly emergent or worsening symptoms. RESULTS: Of 403 participants, 284 completed (70.5%) the trial; 93 (32.7%) were treatment responders. Residual symptoms were common and represented a substantially greater burden than side effects at end point. This was true across symptoms of depression broadly, as captured by items with the QIDS-SR and the MGH CPFQ. CONCLUSIONS: Prospective assessment is crucial to discriminate between residual symptoms and side effects during antidepressant treatment. This study demonstrated that after 6 weeks of active treatment, symptoms are likely to persist despite response to treatment and are much less likely to represent side effects of medication treatment. [ABSTRACT FROM AUTHOR]

BACKGROUND: Psychosocial treatments and medications both have been shown to be effective in treating major depressive disorder. We hypothesized that cognitive-behavioral therapy (CBT) would outperform medication on measures of cognitive change. METHODS: We randomized depressed individuals to 12 weeks of CBT (n = 15) or escitalopram (n = 11). In an intent-to-treat analysis (n = 26), we conducted a repeated measures analysis of variance to examine changes in depressive symptoms (ie, 17-item Hamilton Depression Rating Scale, Beck Depression Inventory), anhedonia (ie, Snaith-Hamilton Pleasure Scale), cognitive measures (ie, Dysfunctional Attitudes Scale, Automatic Thoughts Questionnaire, Perceived Stress Scale), and quality of life (ie, Quality of Life Enjoyment and Satisfaction Questionnaire) at 4 time points: baseline, week 4, week 8, and week 12. Treatment for both groups started at baseline, and patients received either 12 weeks of individual CBT or 12 weeks of escitalopram with flexible dosing (10 to 20 mg). RESULTS: Collapsing the escitalopram and CBT groups, there were statistically significant pre-post changes on all outcome measures. However, there were no statistically significant differences between treatment groups on any of the outcome measures, including cognitive measures across time points. CONCLUSIONS: Our results suggest that both CBT and escitalopram have similar effects across a variety of domains and that, in contrast to our a priori hypothesis, CBT and escitalopram were associated with comparable changes on cognitive measures. [ABSTRACT FROM AUTHOR]

BACKGROUND: We examined whether fatigue was associated with greater symptomatic burden and functional impairment in college students with depressive symptoms. METHODS: Using data from the self-report Beck Depression Inventory (BD1), we stratified a group of 287 students endorsing significant symptoms of depression (BDI score ≥13) into 3 levels: no fatigue, mild fatigue, or moderate/severe fatigue. We then compared the 3 levels of fatigue across a battery of psychiatric and functional outcome measures. RESULTS: Approximately 87% of students endorsed at least mild fatigue. Students with moderate/severe fatigue had significantly greater depressive symptom severity compared with those with mild or no fatigue and scored higher on a suicide risk measure than those with mild fatigue. Students with severe fatigue evidenced greater frequency and intensity of anxiety than those with mild or no fatigue. Reported cognitive and functional impairment increased significantly as fatigue worsened. CONCLUSIONS: Depressed college students with symptoms of fatigue demonstrated functional impairment and symptomatic burden that worsened with increasing levels of fatigue. Assessing and treating symptoms of fatigue appears warranted within this population. [ABSTRACT FROM AUTHOR]

BACKGROUND: The Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire (CPFQ) was developed to assess clinically relevant cognitive and physical symptoms associated with depression that are not adequately assessed by traditional measures. Although the CPFQ has been shown previously to be a reliable and valid measure, the purpose of the present study was to provide additional evidence using larger samples from 4 independent clinical trials that were designed to test the efficacy and safety of different antidepressants. METHODS: The psychometric analyses were based on data from 4 independent clinical trials that were designed to test the safety and efficacy of different antidepressants. Reliability of the items and of the overall questionnaire was evaluated with principal components analysis, whereas validity was assessed by associations of the questionnaire scores with convergent and divergent external criteria. RESULTS: Overall, the results have replicated previous findings that the CPFQ has good internal reliability. Validation also is strengthened by the demonstration of predictive differences among known groups as well as a sensitivity to change with antidepressant treatment. CONCLUSIONS: Results support the use of the CPFQ as a valuable instrument for the detection of clinically relevant symptoms that are not captured by typical measures of depression used for the assessment of treatment outcomes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Suicide among college students is a significant public health concern. Although suicidality is linked to depression, not all depressed college students experience suicidal ideation (SI). The primary aim of this study was to determine potential factors that may distinguish college students with depressive symptoms with and without SI. METHODS: A total of 287 undergraduate college students with substantial depressive symptoms (Beck Depression Inventory [BDI] total score. > 13) with and without SI were compared across psychiatric and functional outcome variables. Independent sample t tests were conducted for each outcome variable using the suicide item of the BDI as a dichotomous (ie, zero vs nonzero score) grouping variable. RESULTS: Relative to students with substantial depressive symptoms without SI, those with SI were more symptomatic overall, having significantly higher levels of depressive symptoms, hopelessness, and anxiety. However, contrary to our expectations, nonsuicidal and suicidal students did not differ on measures of everyday functioning (ie, cognitive and physical functioning and grade point average). CONCLUSIONS: Our findings suggest that SI among college students is associated with increased subjective distress but may not adversely impact physical or cognitive functioning or academic performance. [ABSTRACT FROM AUTHOR]

BACKGROUND: Antidepressant-induced sexual dysfunction affects approximately 50% of patients taking antidepressants. Previous research has explored sildenafil's effectiveness in treating various forms of erectile dysfunction, but there is no research supporting sildenafil's use for improving the quality of life for patients with sexual dysfunction linked to antidepressant use. The authors of this article aimed to assess the improvements in quality of life in patients taking sildenafil to treat antidepressant-induced sexual dysfunction. METHODS: One hundred and two out of 2,239 male and female patients in the follow-up phase of the Sequenced Treatment Alternatives to Relieve Depression antidepressant trials who complained of sexual dysfunction were given sildenafil, 50 to 100 mg, as needed. After 12 months, we measured patients' change in libido, sexual drive, family relationships, overall well-being, satisfaction with treatment, and overall contentment with items on the 17-item Hamilton Depression Rating Scale, Quality of Life Enjoyment and Satisfaction Questionnaire, 30-item Inventory of Depressive Symptoms, and 12-item Short Form Health Survey. RESULTS: There was a significant association between sildenafil use and improvement in libido and sexual drive by month 6. There was no significant improvement in the quality-of-life scores we examined, but treatment satisfaction and overall contentment increased over time. CONCLUSIONS: Despite no direct association with sildenafil use and quality-of-life scores, sildenafil may be a beneficial treatment for antidepressant-induced sexual dysfunction. A double-blind, placebo-controlled study of sildenafil in antidepressant-induced sexual dysfunction is needed to further explore its potential benefits. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although research suggests depression is common among individuals with Parkinson's disease (PD), it is unclear how to best assess depression in PD (dPD). We wanted to examine the prevalence of dPD using different definitions of depression, as well as examine factors associated with dPD. METHODS: One hundred fifty-eight individuals (68% male; age 66.8 ± 9.6 SD) with a primary diagnosis of PD were assessed for depression using the Harvard Department of Psychiatry/National Depression Screening Day Scale (HANDS) in an outpatient setting at the Movement Disorders Clinic at Massachusetts General Hospital. We defined depression using 4 thresholds based on the HANDS and whether or not an individual was ever on an antidepressant regimen. We also examined potential predictors of the presence of dPD. RESULTS: The prevalence of depression among study participants ranged from 11% to 57%, depending on which of the 4 definitions of depression was applied. Younger age and longer duration of PD predicted a relatively higher prevalence of depression. Having a history of depression prior to onset of PD also was predictive of dPD. CONCLUSIONS: Depression appears to be relatively common among individuals with PD, and history of depression, younger age, and longer PD duration may be factors associated with dPD. [ABSTRACT FROM AUTHOR]

BACKGROUND: The purpose of this study was to examine whether treatment response to fluoxetine by depressed outpatients was predicted by early improvement on any of 3 subscales (Anxiety, Depression, and Anger/ Hostility) of the Symptom Questionnaire (SQ). METHODS: We evaluated 169 depressed outpatients (52.6% female) between ages 18 and 65 (mean age, 40.3 ± 10.6 years) meeting DSM-IIIR criteria for major depressive disorder (MDD). All patients completed the SQ at baseline (week 0) and at weeks 2, 4, and 8 of treatment with fluoxetine 20 mg/d. We defined treatment response as a ≥50% reduction in score on the 17-item Hamilton Rating Scale for Depression, and early improvement on 3 SQ subscales (Anxiety, Depression, and Anger/Hostility) as a ≥30% reduction in score by week 2. RESULTS: The percentage of patients with significant early improvement in anger was significantly greater than the percentage of those with early improvements in anxiety or depression. When early improvement on the Anxiety, Depression, and Anger/Hostility subscales of the SQ were assessed independently by logistic regression, all 3 subscales were predictors of response to treatment. CONCLUSIONS: Early improvement in anger, anxiety, and depressive symptoms may predict response to antidepressant treatment among outpatients with MDD. [ABSTRACT FROM AUTHOR]

Background: To identify putative demographic and clinical variables that correlate with antidepressant response to the SNRI duloxetine in major depression. Methods: The effect of 130 candidate treatment outcome predictors was examined on 3 dependent treatment outcome measures related to depression: 1) depression symptom outcome measured by HAMD-17 total and HAMD-17 percent change from baseline to endpoint, 2) remission (HAMD-17 ≤ 7 at endpoint) and response (≥ 50% reduction in HAMD-17 from baseline to endpoint) rates, and 3) time to response (days to ≥ 50% reduction in HAMD-17). Results: Eleven variables had an overall predictive index of ≥ 20% and were associated with poorer treatment outcome: HAMD-17 total, duration of current MDD episode, leaden paralysis, fatigue, HAMA total, HAMA items 2 and 8, HAMD-17 anxiety/somatization subscale, anxiety-related comorbid conditions, and VAS overall pain and pain while awake. Conclusions: Our results highlight the clinical relevance of more severe and/or persistent levels of depression, psychiatric and medical comorbidity, and symptoms characteristic of atypical depression (leaden paralysis and fatigue) and confirm findings from other studies that such patients may respond less well or take longer to respond to pharmacotherapy. Consistent with previous SNRI studies, we found no significant association between age, gender, and race/ethnicity and treatment outcome. [ABSTRACT FROM AUTHOR]

Background. The purpose of this study was to examine associations between clinical and demographic characteristics of depressed patients and source of payment for care. We attempted to confirm and extend findings from a previous study regarding the first 1500 participants enrolled in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study with 2541 participants enrolled in later stages of the trial. Methods. Demographic, clinical, and presenting symptom features were compared among participants with public, private or no insurance. Results. Compared to those having private or no insurance, participants with public insurance were older; more likely to be women, Hispanic, widowed or divorced, unemployed, and less educated; were more frequently seen in primary care; had greater medical comorbidity and functional impairment, and a later age of depression onset. The publicly insured also had a longer current episode, but fewer episodes over their lifetime. Both the publicly insured and the uninsured had poorer life satisfaction compared to those with private insurance. Participants without insurance were intermediate between those with public and private insurance regarding several demographic characteristics and measures of severity. Conclusions. Depressed outpatients with public insurance demonstrated greater functional impairment, though they did not have a more severe depression per se. Participants without insurance seemed to be a heterogeneous group with a presentation intermediate between those with public and private insurance. Those with public insurance were overrepresented in primary care clinics; therefore, clinicians in these settings need to be particularly vigilant in recognizing depression and offering appropriate treatments. [ABSTRACT FROM AUTHOR]

Background. The purpose of this study was to study hopelessness as a predictor of response to fluoxetine in outpatients with Major Depressive Disorder (MDD). Methods. The degree of hopelessness was assessed during the baseline visit with the use of the Beck Hopelessness Scale (BHS) in 312 patients with MDD (56.1% women; 39.8 ± 10.3 years of age) who entered an 8-week, 20-mg, fixed-dose, open trial of fluoxetine. With the use of a logistic regression we tested whether BHS scores at baseline predicted clinical response, controlling for the severity of depression as reflected by the total score on the 17-item Hamilton Depression Rating Scale (HAM-D-17). With the use of a multiple regression we also tested whether BHS scores at baseline predicted HAM-D-17 scores at endpoint, controlling for HAM-D-17 scores at baseline. Results. After controlling for depression severity at baseline, a greater degree of hopelessness was found to significantly increase the risk of non-response to fluoxetine (p = 0.0413), as well as the risk of greater endpoint depression severity (p = 0.0305). Conclusions. Hopelessness appeared to be associated with poorer response to treatment with fluoxetine in MDD, and this was independent of depression severity. Similar studies involving treatment with higher doses of fluoxetine and for greater duration as well as a placebo comparator arm are needed to further explore the relationship between hopelessness, placebo response and drug response. [ABSTRACT FROM AUTHOR]

Background . The purpose of this paper is to use demographic and clinical data from a large diverse group of outpatients diagnosed with non-psychotic major depression to investigate the validity of the DSM-IV concept of melancholic depression. Methods . Baseline clinical and demographic data were collected on 1500 outpatients (1456 of whom melancholia could be determined) with non-psychotic major depressive disorder (MDD) participating in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Depressive symptom severity was assessed by clinical telephone interview using the 17-item Hamilton Rating Scale for Depression (HRS-D 17 ) and the 30-item Inventory of Depressive Symptomatology (IDS-C 30 ). The types and degrees of concurrent psychiatric symptoms were measured using a self report, the Psychiatric Diagnostic Screening Questionnaire (PDSQ), by recording the number of items relevant to each diagnostic category endorsed by study participants. Results . Adjusting for severity of depression (as measured by the total HRS-D 17 scores), no differences were found in the rate of melancholic depression by race, marital status, education, employment status, family history of depression, primary care versus specialty care, monthly income, and degree of psychiatric and medical co-morbidity. Melancholic depression was significantly more likely in men than women. Melancholic depression after adjustment for severity was associated with a slightly younger age at study entry, as well as with greater illness severity, and slightly shorter duration of current episode. Hispanic ethnicity was associated with lower melancholic depression rates at the .06 level of significance. Conclusions . Among outpatients with MDD, melancholic features were less likely in Hispanic patients, but more likely in slightly younger patients and in men. Melancholic features were also related to a slightly shorter current episode. These findings are consistent with the notion that external socio-demographic factors do not play an important role in the pathophysiology of melancholic depression. [ABSTRACT FROM AUTHOR]

Background. Approximately half of all treated depressed patients fail to show adequate response to their initially prescribed antidepressant medication. Switching to another medication represents one possible next-step approach for nonresponsive or partially responsive patients. However, specific techniques for switching between antidepressants have not been well studied. We examined the efficacy and tolerability associated with a switch from a selective serotonin reuptake inhibitor (SSRI) or venlafaxine to duloxetine. Methods. All patients met criteria for major depressive disorder as defined in DSM-IV. Patients (N = 88) exhibiting suboptimal response or poor tolerability to their current antidepressant medication (citalopram ≤40 mg/d, escitalopram ≤20 mg/d, fluvoxamine ≤150 mg/d, paroxetine ≤40 mg/d, sertraline ≤150 mg/d, or venlafaxine ≤150 mg/d) were switched to duloxetine 60 mg once-daily (QD) without intermediate tapering or titration (“switching” group). A comparator group (N = 67), comprising patients not currently receiving antidepressant medication, initiated duloxetine therapy at 60 mg QD (“initiating” group). Safety assessments included comparisons of discontinuation rates, treatment-emergent adverse events, and changes in vital signs. Efficacy measures included the HAMD 17 , Hamilton Anxiety Scale (HAMA), and the Clinical Global Impression of Severity (CGI-S) scale. Results. The efficacy of duloxetine in switched patients did not differ significantly from that observed in untreated patients initiating duloxetine therapy (mean changes: HAMD 17 total score: -12.3 vs. -12.6; HAMA: -9.36 vs. -9.55, CGI-S: -1.94 vs. -2.12, respectively). However, the rate of discontinuation due to adverse events among patients switched to duloxetine was significantly lower than that in patients initiating duloxetine therapy (4.5% vs. 17.9%, p = .008). Treatment-emergent adverse events occurring in ≥10% of patients in both treatment groups were nausea, headache, dry mouth, insomnia, and diarrhea. Patients switched to duloxetine reported significantly lower rates of nausea and fatigue compared with patients initiating duloxetine. Conclusions. In this study, the efficacy of duloxetine in switched patients was comparable to that observed in patients initiating duloxetine therapy. Immediate switching from an SSRI or venlafaxine to duloxetine (60 mg QD) was well tolerated. [ABSTRACT FROM AUTHOR]

Background. There is a paucity of naturalistic studies from depression specialty clinics describing the next-step (augmentation versus switching) practices of clinicians for outpatients with major depressive disorder (MDD) resistant to an antidepressant trial of adequate dose and duration. Methods. Eighty-five MDD outpatients enrolled in one of two specialty clinics, who had not achieved remission after a first adequate prospective antidepressant trial conducted at the clinic underwent either augmentation (n = 36) or switching (n=49) of their antidepressant regimen. Outcome was defined with the use of the Clinical Global Impressions (CGI) Scale. Results. Nonresponders (CGI-I>3) following the first antidepressant trial were more likely to have their treatment switched than patients who experienced incomplete response (CGI-I<4, CGI-S>1) (67.2% versus 28.5%, p = 0.001). Incomplete responders during the first trial who went on to receive augmentation had higher remission rates (60.0% versus 0%, p=0.01), lower endpoint depression severity scores (1.8 ±1.1 versus 3.3 ± 0.8, p = 0.01) and greater clinical improvement scores (1.6 ±1.1 versus 3.0 ±0.0, p=0.03) than incomplete responders who had their antidepressant regimen switched. Although nonresponders to the first treatment who were switched experienced greater symptom improvement than nonresponders who were augmented (2.7 ±1.1 versus 3.4 ± 1.2, p=0.03), there was no significant difference (p>0.05) between these two groups with respect to remission rates (18.6% versus 14.2%, respectively) and endpoint depressive severity (3.0 ±1.4 versus 3.4 ±1.4, respectively). Conclusions. In this nonrandomized, naturalistic treatment setting, nonresponders to an adequate, prospective antidepressant trial were more likely to have their antidepressant regimen switched, while patients with incomplete response during the first trial were more likely to have their regimen augmented. In addition, patients with incomplete response who had their treatment augmented had better outcome than patients with incomplete response who had their treatment switched. [ABSTRACT FROM AUTHOR]