抑郁自评量表的因子分析

目的：探讨抑郁自评量表(SDS)的因子结构组成。方法：采用随机抽样方法，对在山东省三个不同的农村社区居住的336人用抑郁自评量表进行调查，并进行因子分析。结果抑郁自评量表20个题目经因子分析可提取4个因子，分别为躯体症状和焦虑、乐观情绪、生理状态及恶劣心境。结论：抑郁自评量表可分为4个因子，通过4个因子能更准确地反映出所探查的抑郁症状的不同方面。     

脑梗死急性期并发抑郁症的临床分析

脑梗死急性期的抑郁症状可直接影响神经功能障碍的恢复。为探讨脑梗死急性期患者的抑郁特点及治疗方法,作者应用汉米尔顿抑郁量表（HAMD）、Zung氏抑郁自评量表（SDS）对39例脑梗死抑郁患者进行评定。     

儿童抑郁障碍自评量表的河南农村常模和信效度

目的:对儿童抑郁障碍自评量表应用于河南农村儿童的信效度检验,并建立河南农村常模.方法:在河南全省6个市6个乡镇小学校中采样1742人(男900,女842),平均年龄(11.6±1.7)岁,同时抽取抑郁障碍患儿47例,填写儿童抑郁障碍自评量表. 结果:量表项目分析中各条目与总分相关系数r在0.318 ～0.645之间(P＜0.01).各项目内部一致性Cronbach α系数为0.730.重测信度r=0.686(P ＜0.01).抑郁儿童得分低于常模儿童(t=-8.839,P=0.000).根据ROC曲线,常模划界分为14. 结论:儿童抑郁障碍自评量表可用于河南农村儿童抑郁症状的评估,并可用于儿童抑郁障碍的筛查.     

精神分裂症患者自评与他评症状量表差异的相关因素分析

目的:探讨精神分裂症患者自评与他评量表差异及与人口学资料、自知力、临床症状的相关因素分析。方法:对236例精神分裂症患者进行症状自评量表(SCL-90)精神病性症状分量表自评及阳性和阴性症状量表(PANSS)量表他评。比较自评与他评量表高差异与低差异两组间人口学资料、自知力、临床症状,并进行回归分析。结果:SCL-90精神病性症状分量表与PANSS总分有相关性(r=0.343,P0.05);受教育年限、阳性症状分和疾病认识分的差异进入Logistic回归模型。结论:阳性症状、疾病认识、受教育年限是患者自评与他评症状差异的相关因素。自评量表可以多角度地评估精神分裂症患者的症状。     

201例妇女孕期产后心理状态调查

目的:探讨孕期及产后妇女心理状况并分析相关影响因素。方法:对201例孕妇,采用焦虑自评量表(SAS)、抑郁自评量表(SDS)和爱丁堡产后抑郁量表(EPDS),在孕6个月后至分娩,产后1周、4周和12周4个时点进行心理状况评估。结果:4个时点焦虑症状发生率分别为3.48%、2.49%、1.00%和0.50%。产前抑郁症状的发生率11.94%,产后抑郁症状的发生率分别是22.39%,7.46%和9.95%。结论:妊娠及分娩对孕产妇心理有明显影响。     

抑郁自评量表(SDS)

抑郁自评量表(Self-Rating Depression Scale,SDS)是一个含有20个项目、分为4级评分的自评量表。它原型是Zung Depression Scale(Zung抑郁量表,1965),其特点是使用简便,並能相当直观地反映忧郁病人的主观感受。项目、定义和评分标准 SDS采用4级评分,主要评定症状出现     

抑郁症急性期疗效与巩固期服药依从性的多中心队列研究

目的:探讨抑郁症患者急性期疗效对巩固期服药依从性的影响。方法:入组急性期治疗结束的抑郁症患者428例,290例完成6个月随访,分为依从性好组(202例)和依从性差组(88例)。使用16项抑郁症状快速评估量表(QIDS-SR16)、健康问卷躯体化症状群量表(PHQ-15)、广泛性焦虑自评量表(GAD-7)、简明幸福与生活质量满意度问卷(Q-LES-Q-SF)、席汉残疾量表(SDS)等评估急性期治疗结束抑郁症残留症状、生命质量与社会功能对患者巩固期服药依从性的影响。结果:依从性差组QIDS总分、QIDS-5、QIDS-11、QIDS-13、QIDS-14、PHQ-15总分、GAD-7总分、SDS-03得分高于依从性好组,Q-LES-Q-SF总分低于依从性好组,组间差异有统计学意义(P0.05或P0.01)。多元Logistic回归分析显示急性期末PHQ-15总分及QIDS-11得分与巩固期服药依从性差有显著关联(P0.05)。结论:抑郁症急性期治疗后残留症状越多、生活质量越差,患者巩固期服药依从性越差。     

氟西汀治疗糖尿病伴情绪障碍对照研究

目的:探讨氟西汀对糖尿病(DM)患者伴抑郁、焦虑的疗效.方法:将75例伴抑郁焦虑症状的DM患者随机分为加用氟西汀组和仅以内科治疗的对照组,疗程6周.采用抑郁自评量表(SDS)、焦虑自评量表(SAS)及副反应量表(TESS)进行评定.结果:氟西汀组抑郁症状、焦虑症状的有效率分别为67.7%、55.6%,明显高于对照组,且DM控制情况好,无严重不良反应.结论:氟西汀适宜于治疗DM患者伴有的抑郁、焦虑症状.     

首发精神分裂症病人的抑郁症状

目的探讨首发精神分裂症病人抑郁症状的发生率、特征及相关因素。方法于入院、治疗3、6、9、12月时用汉密尔顿抑郁量表(HAMD)、简明精神病评定量表(BPRS)、阴性症状量表中文版(SANS-CV)、临床总体印象量表(CGI)及功能总体评定量表(GAF)对164例首发精神分裂症患者进行评定。结果急性期首发精神分裂症病人轻度或以上程度抑郁症状的发生率为71%,但在缓解期降至12%。急性期突出的抑郁表现为认知障碍与迟缓(因子分各占HAMD总分的35%和29%)。抑郁症状随着精神病性症状的缓解而减轻,与性别、发病年龄、受教育时间、病程及前驱期长短无关。HAMD总分在急性期仅与BPRS的焦虑抑郁因子分有关,但在缓解期与阴阳性症状、临床总体印象以及总体功能均有密切的相关性;急性期以及治疗3个月时的抑郁症状与随后的阴阳性症状、总体功能的变化无关。结论首发精神分裂症急性期的抑郁症状可能是一个独立的症状群,抑郁程度不能作为预测首发精神分裂症病人预后的指标。     

A型肉毒毒素局部注射治疗对偏侧面肌痉挛患者生活质量的影响

目的 探讨A型肉毒毒素(BTXA)局部注射治疗对偏侧面肌痉挛(HFS)患者生活质量的影响.方法 给予108例HFS患者BTXA局部肌肉注射治疗.在治疗前、治疗后3及6个月时应用Cohen分级标准进行痉挛程度及疗效评价,用生活质量量表(QOL-BREF)、抑郁自评量表(SDS)、焦虑自评量表(SAS)进行测评.结果 治疗后3及6个月时Cohen分级较治疗前明显下降;治疗3个月时显效率及总有效率为90.1％、100％,6个月时为83.3％、96.3％.与治疗前比较,治疗3及6个月时除环境评分外,各项QOL-BREF量表评分明显提高,SDS及SAS评分明显降低(均P＜0.05);有抑郁及焦虑情绪的比率明显降低(均P＜0.05).结论 BTXA治疗HFS疗效显著,并能明显改善其健康相关生存质量.     

线上结构式团体认知行为治疗对轻症抑郁患者的有效性和可行性探索

目的探讨线上结构式团体认知行为治疗(internet-based structured group cognitive behavior therapy,I-GCBT)对轻症抑郁患者的有效性和可行性。方法使用SPSS20.0软件生成随机表,将96例轻症抑郁患者分配到线上视频团体干预组(线上组,n=64)与面对面干预组(线下组,n=32),使用HAMD17、HAMA、功能大体评定量表(Global Assessment of Functioning Scale,GAF)以及抑郁症状快速检查-自我报告评分16项(16 Items Quick Inventory of Depressive Symptomatology-Self Report,QIDS-SR16)分别在基线、4周末、8周末和12周末评估患者抑郁、焦虑及整体功能水平。采用重复测量方差分析比较两组治疗效果差异,采用卡方检验比较两组脱落率、治愈率、治疗接受度差异。结果(1)2组患者基线HAMA评分差异有统计学意义(t=-2.08,P=0.04),其他基线数据差异无统计学意义。(2)对患者在组别和时间的交互作用分析显示,HAMD17、HAMA和QIDS-SR16的时间与组别交互作用均不显著(F=0.69,P>0.05;F=0.95,P>0.05;F=0.64,P>0.05),GAF的时间与组别交互作用显著(F=4.09,P<0.01),2组患者在各量表上时间主效应均显著(HAMD17:F=32.81,P<0.01;HAMA:F=20.86,P<0.01;GAF:F=105.98;P<0.01;QIDS-SR16:F=25.27,P<0.01)。12周末临床治愈率达62%(43/69),线上组57%(25/44),线下组72%(18/25),差异无统计学意义(χ^2=1.57,P=0.21)。(3)治疗期间总体脱落率为26%(21/81),线上组29%(15/51),线下组20%(6/30),2组比较差异无统计学意义(χ^2=0.87,P=0.35),患者对方案的接受程度达97%(58/60),线上组97%(35/36),线下组96%(23/24),2组比较差异无统计学意义(χ^2=0.09,P=0.78)。结论线上结构式团体认知行为治疗对轻症抑郁患者的疗效与面对面干预组相当,患者依从性较好。     

Efficacy of olanzapine in combination with valproate or lithium in the treatment of mania in patients partially nonresponsive to valproate or lithium monotherapy.

BACKGROUND: A 6-week double-blind, randomized, placebo-controlled trial was conducted to determine the efficacy of combined therapy with olanzapine and either valproate or lithium compared with valproate or lithium alone in treating acute manic or mixed bipolar episodes. METHODS: The primary objective was to evaluate the efficacy of olanzapine (5-20 mg/d) vs placebo when added to ongoing mood-stabilizer therapy as measured by reductions in Young Mania Rating Scale (YMRS) scores. Patients with bipolar disorder (n = 344), manic or mixed episode, who were inadequately responsive to more than 2 weeks of lithium or valproate therapy, were randomized to receive cotherapy (olanzapine + mood-stabilizer) or monotherapy (placebo + mood-stabilizer). RESULTS: Olanzapine cotherapy improved patients' YMRS total scores significantly more than monotherapy (-13.11 vs -9.10; P = .003). Clinical response rates (> or = 50% improvement on YMRS) were significantly higher with cotherapy (67.7% vs 44.7%; P< .001). Olanzapine cotherapy improved 21-item Hamilton Depression Rating Scale (HAMD-21) total scores significantly more than monotherapy (4.98 vs 0.89 points; P< .001). In patients with mixed-episodes with moderate to severe depressive symptoms (DSM-IV mixed episode; HAMD-21 score of > or = 20 at baseline), olanzapine cotherapy improved HAMD-21 scores by 10.31 points compared with 1.57 for monotherapy (P< .001). Extrapyramidal symptoms (Simpson-Angus Scale, Barnes Akathisia Scale, Abnormal Involuntary Movement Scale) were not significantly changed from baseline to end point in either treatment group. Treatment-emergent symptoms that were significantly higher for the olanzapine cotherapy group included somnolence, dry mouth, weight gain, increased appetite, tremor, and slurred speech. CONCLUSION: Compared with the use of valproate or lithium alone, the addition of olanzapine provided superior efficacy in the treatment of manic and mixed bipolar episodes.     

Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report

OBJECTIVE: This report describes the participants and compares the acute and longer-term treatment outcomes associated with each of four successive steps in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. METHOD: A broadly representative adult outpatient sample with nonpsychotic major depressive disorder received one (N=3,671) to four (N=123) successive acute treatment steps. Those not achieving remission with or unable to tolerate a treatment step were encouraged to move to the next step. Those with an acceptable benefit, preferably symptom remission, from any particular step could enter a 12-month naturalistic follow-up phase. A score of or=11 (HRSD(17)>or=14) defined relapse. RESULTS: The QIDS-SR(16) remission rates were 36.8%, 30.6%, 13.7%, and 13.0% for the first, second, third, and fourth acute treatment steps, respectively. The overall cumulative remission rate was 67%. Overall, those who required more treatment steps had higher relapse rates during the naturalistic follow-up phase. In addition, lower relapse rates were found among participants who were in remission at follow-up entry than for those who were not after the first three treatment steps. CONCLUSIONS: When more treatment steps are required, lower acute remission rates (especially in the third and fourth treatment steps) and higher relapse rates during the follow-up phase are to be expected. Studies to identify the best multistep treatment sequences for individual patients and the development of more broadly effective treatments are needed.     

Adaptation and validation of the Spanish version of the Mood Disorder Questionnaire for the detection of bipolar disorder

Objective: The Mood Disorder Questionnaire (MDQ) is an instrument for the detection of patients with bipolar disorder (BD). The original English version is validated in both the psychiatric and the general population, but a validated Spanish version is not yet available. Psychometric properties of the Spanish adaptation of the MDQ in psychiatry are described. Methods: The MDQ is a self‐administered questionnaire comprising a list of 13 hypomanic symptoms and two questions about concurrence of symptoms and functional impairment caused by the symptoms. We selected patients from 15 psychiatric outpatient departments, diagnosed with BD type I and II (BDI and BDII) and major depression (MD) according to DSM‐IV‐TR criteria (concurrent validity instrument). A control group of healthy subjects (HS) was selected. The patient‐selection criteria included stability of the disorder and pharmacological treatment. The MDQ was administered to 236 subjects, distributed among the four groups, on two occasions, four weeks apart. We analysed the internal consistency, test–retest reliability, and discriminative capacity of the MDQ for the detection of patients with BD. Results: Concurrent validity based on diagnosis according to DSM‐IV‐TR was 0.83. The internal consistency, evaluated by Cronbach’s α, was 0.90. The mean (SD) number of affirmative responses by group was: 9.8 (2.4) for BDI, 8.5 (2.8) for BDII, 2.7 (2.2) for MD, and 1.02 (1.9) for HS. Statistically significant differences between all the groups were found (Kruskal–Wallis test, p < 0.001). Concurrent validity using the diagnostic variable was 0.83. Test–retest reliability was 0.92. We analysed the scale’s discriminative capacity, revealing a sensitivity value of 0.60 [95% confidence interval (CI) = 0.51–0.69] and a specificity value of 0.98 (95% CI = 0.94–0.99) in the detection of BD. The positive and negative probability ratios were 35.5 and 2.4, respectively. If we consider only seven positive responses as the discriminative criterion, sensitivity increases to 0.81 (95% CI = 0.73–0.88), the specificity value is 0.95 (95% CI = 0.89–0.98) and the positive and negative probability quotients are 16 and 5.3. Conclusions: The psychometric characteristics of the Spanish version are similar to those of the original version. In the Spanish adaptation of the MDQ, seven positive responses to hypomanic symptoms show a good discriminative capacity for BD in patients attending psychiatric outpatient facilities; therefore, this cut‐off score is proposed for the detection of BD in psychiatric outpatients.     

Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice

OBJECTIVE: Selective serotonin reuptake inhibitors (SSRIs) are widely used to treat depression, but the rates, timing, and baseline predictors of remission in "real world" patients are not established. The authors' primary objectives in this study were to evaluate the effectiveness of citalopram, an SSRI, using measurement-based care in actual practice, and to identify predictors of symptom remission in outpatients with major depressive disorder. METHOD: This clinical study included outpatients with major depressive disorder who were treated in 23 psychiatric and 18 primary care "real world" settings. The patients received flexible doses of citalopram prescribed by clinicians for up to 14 weeks. The clinicians were assisted by a clinical research coordinator in the application of measurement-based care, which included the routine measurement of symptoms and side effects at each treatment visit and the use of a treatment manual that described when and how to modify medication doses based on these measures. Remission was defined as an exit score of or=50% in baseline QIDS-SR score. RESULTS: Nearly 80% of the 2,876 outpatients in the analyzed sample had chronic or recurrent major depression; most also had a number of comorbid general medical and psychiatric conditions. The mean exit citalopram dose was 41.8 mg/day. Remission rates were 28% (HAM-D) and 33% (QIDS-SR). The response rate was 47% (QIDS-SR). Patients in primary and psychiatric care settings did not differ in remission or response rates. A substantial portion of participants who achieved either response or remission at study exit did so at or after 8 weeks of treatment. Participants who were Caucasian, female, employed, or had higher levels of education or income had higher HAM-D remission rates; longer index episodes, more concurrent psychiatric disorders (especially anxiety disorders or drug abuse), more general medical disorders, and lower baseline function and quality of life were associated with lower HAM-D remission rates. CONCLUSIONS: The response and remission rates in this highly generalizable sample with substantial axis I and axis III comorbidity closely resemble those seen in 8-week efficacy trials. The systematic use of easily implemented measurement-based care procedures may have assisted in achieving these results.     

Safety,Tolerability, and Real-World Effectiveness of Intravenous Ketamine in Older Adults With Treatment-Resistant Depression: A Case Series

ObjectiveTo evaluate the safety, tolerability, and effectiveness of repeated doses of intravenous (IV) ketamine in older adults (i.e., ≥60 years of age) with treatment-resistant depression.MethodIn this case series, fifty-three older adults (M_age = 67, SD = 6; 57% female [n = 30]) received 4 IV ketamine infusions, administered over 1–2 weeks. Effectiveness of IV ketamine was measured using the Quick Inventory for Depressive Symptomatology–Self Report 16 (QIDS-SR16) approximately 2 days after infusions 1–3, and 1–2 weeks after infusion 4. Safety was measured as hemodynamic changes before, during, immediately after, and 20 minutes after each infusion. Tolerability was assessed via systematic reporting of treatment-emergent adverse events during and after each infusion, in addition to symptoms of dissociation measured using the Clinician Administered Dissociative States Scale. Partial response (25%–50% symptomatic improvement from baseline), response (≥50% symptomatic improvement from baseline), clinically significant improvements (≥25% symptomatic improvement from baseline), and remission rates (QIDS-SR16 ≤5) were also calculated.ResultsParticipants reported significant decreases in depressive symptoms (i.e., as measured by the QIDS-SR16) with repeated ketamine infusions (F(4, 92) = 7.412, p <0.001). The mean QIDS-SR16 score was 17.12 (SD = 5.33) at baseline and decreased to 12.52 (SD = 5.79) following 4 infusions. After 4 infusions, 31% (n = 8) of participants partially responded to IV ketamine, 27% (n = 7) responded, 58% (n = 15) experienced clinically significant improvements, and 10% (n = 3) met remission criteria. Thirty-six participants (69%) experienced treatment-emergent hypertension during at least 1 infusion, and 10 (19%) required intervention with an antihypertensive. Drowsiness was the most commonly reported adverse event (50% of infusions; n = 73).ConclusionKetamine was associated with transient treatment-emergent hypertension. Response and remission rates were comparable to those reported in general adult samples. Findings are limited by the open-label, chart review nature of this study.     

Improving outcomes in depression: a focus on somatic symptoms

BACKGROUND: It is hypothesized that somatic symptom alleviation is a significant predictor of overall outcome in depressed primary care patients. METHODS: Depressed primary care patients (N=205) meeting DSM-IV-TR criteria received open-label antidepressant therapy. The primary symptom measurement tool used was the 17-item Hamilton Depression Rating Scale (HAMD-17), with the Montgomery-Asberg Depression Rating Scale (MADRS) and the Clinical Global Impression Improvement/Severity (CGI-I/S) used as secondary measures. As proxies for somatic symptoms, 8 items from the HAMD-17 (HAMD-S) and 3 items from the MADRS (MADRS-S) that measure somatic symptoms were identified and extracted. RESULTS: There was a significant correlation between improvement on the HAMD-S score and overall reduction on the MADRS total score (r=.766, P<.001), response (r=.594, P<.001), and remission (r=.552, P<.001). Improvement on the MADRS-S also correlated with overall HAMD-17 improvement (r=.782, P<.001), along with response (r=.649, P<.001) and remission (r=.539, P<.001) rates. Both the HAMD-S and the MADRS-S correlated with global improvement as measured by the CGI-I/S (P<.001). CONCLUSIONS: A reciprocal interaction between somatic symptoms and other depressive-symptom domains is implied by this analysis. Clinicians are encouraged to identify, track, and target the somatic symptoms of depressive illnesses.     

A psychometric evaluation of the clinician‐rated Quick Inventory of Depressive Symptomatology (QIDS‐C16) in patients with bipolar disorder

The clinician‐rated, 16‐item Quick Inventory of Depressive Symptomatology (QIDS‐C₁₆) has been extensively evaluated in patients with major depressive disorder (MDD). This report assesses the psychometric properties of the QIDS‐C₁₆ in outpatients with bipolar disorder (BD, N = 405) and MDD (N = 547) and in bipolar patients in the depressed phase only (BD‐D) (N = 99) enrolled in the Texas Medication Algorithm Project (TMAP) using classical test theory (CTT) and the Samejima graded item response theory (IRT) model. Values of coefficient alpha were very similar in BD, MDD, and BD‐D groups at baseline (α = 0.80–0.81) and at exit (α = 0.82–0.85). The QIDS‐C₁₆ was unidimensional for all three groups. MDD and BD‐D patients (n = 99) had comparable symptom levels. The BD‐D patients (n = 99) had the most, and bipolar patients in the manic phase had the least depressive symptoms at baseline. IRT analyses indicated that the QIDS‐C₁₆ was most sensitive to the measurement of depression for both MDD patients and for BD‐D patients in the average range. The QIDS‐C₁₆ is suitable for use with patients with BD and can be used as an outcome measure in trials enrolling both BD and MDD patients. Copyright © 2009 John Wiley & Sons, Ltd.     

The Quick Inventory of Depressive Symptomatology, Clinician Rated and Self-report: A Psychometric Assessment in Chinese Americans With Major Depressive Disorder

ABSTRACT: This study aimed to investigate the psychometric properties of the Chinese translations of the Quick Inventory of Depressive Symptomatology (QIDS16), including the Clinician-Rated (QIDS-C16), Self-report (QIDS-SR16), and Interactive Voice Response (QIDS-SR-IVR16) formats. Thirty depressed Chinese Americans were assessed with Chinese translations of the QIDS-SR16, QIDS-SR-IVR16, and QIDS-C16. Cronbach alpha estimates of internal scale consistency on the QIDS-SR16, QIDS-SR-IVR16, and QIDS-C16 were 0.70, 0.74, and 0.79, respectively. Intercorrelations among the measures were QIDS-SR16 and QIDS-SR-IVR16, r = 0.79; QIDS-SR16 and QIDS-C16, r = 0.61; and QIDS-SR-IVR16 and QIDS-C16, r = 0.69 (all p values < 0.01). The areas under the curve for the receiver operating characteristics of the QIDS-SR16 and QIDS-SR-IVR16 were 0.78 (95% confidence interval, 0.61-0.95) and 0.81 (95% confidence interval, 0.65-0.96), respectively. The respective screening sensitivities/specificities were 0.73/0.74 and 0.86/0.58. The Chinese translations of the QIDS16 have adequate psychometric properties and may be useful tools for depression screening.     

A comparison of mirtazapine and nortriptyline following two consecutive failed medication treatments for depressed outpatients: a STAR*D report

OBJECTIVE: Few controlled studies have addressed the issue of which antidepressant medications should be recommended for outpatients who have not responded to multiple treatment trials. This study compared the efficacy of switching to mirtazapine to that of switching to a tricyclic antidepressant (nortriptyline) following two prospective, consecutive, unsuccessful medication treatments for nonpsychotic major depressive disorder. METHOD: Following lack of remission or an inability to tolerate an initial trial of citalopram for up to 12 weeks (first step) and a second trial with either monotherapy involving another antidepressant or augmentation of citalopram with bupropion or buspirone (second step), adult outpatients (N=235) with nonpsychotic major depressive disorder were randomly assigned to 14 weeks of treatment with mirtazapine (up to 60 mg/day) (N=114) or nortriptyline (up to 200 mg/day) (N=121). The primary outcome, symptom remission, was defined a priori as a total exit score of /=50% reduction in score from baseline). RESULTS: For mirtazapine, remission rates were 12.3% and 8.0% per the Hamilton and QIDS-SR(16) scores, respectively. For nortriptyline, remission rates were 19.8% and 12.4%, respectively. QIDS-SR(16) response rates were 13.4% for mirtazapine and 16.5% for nortriptyline. Neither response nor remission rates statistically differed by treatment, nor did these two treatments differ in tolerability or adverse events. CONCLUSIONS: Switching to a third antidepressant monotherapy regimen after two consecutive unsuccessful antidepressant trials resulted in low remission rates (<20%) among patients with major depressive disorder.