The Effectiveness of Sertraline in Patients Who Have Had Inadequate Response to Escitalopram

Eight week open-label flexible dose trial in adult outpatients diagnosed with Major Depressive Disorder (MDD) who have had a prior failure with escitalopram. Failure is operationally defined as either premature discontinuation because of side effects or the report of an incomplete response to escitalopram, minimum dose 10mg/day, maintain for 3 weeks or more. 10mg/day was chosen because 1) it is the most commonly prescribed single dose of escitalopram in clinical practice, 2) it is equivalent to approx. 30mg/day of arcemic citalopram and 3) escitalopram has very high potency at the serotonin transporter (Ki=1.1); this means that escitalopram would be expected to saturate the transporter at relatively low doses. A total of twenty patients will be treated.

Inclusion criteria

• Primary DSM-IV diagnosis of Major Depressive episode of MDD without psychotic symptoms. Additional axis I diagnoses will be permitted only if they are identified as secondary diagnoses
• Ham-D 21 item score of greater than or equal to 18
• Age 18 and above
• Ability and willingness to provide consent for participation
• Failure to respond to escitalopram

Exclusion criteria

• Diagnosis of Bipolar Disorder or any psychotic disorder
• Alcohol or drug abuse or dependence currently or in the last 6 months
• A history of non-response or intolerance to sertraline at least 50 mg. for at least 4 weeks or more
• Concomitant use of another antidepressant or use of an antidepressant within 2 weeks of baseline (4 weeks for fluoxetine)
• Use within 1 week of baseline, or concomitant use of any psychotropics with the exception of zolpidem for sleep
• Use within 4 weeks of baseline or concomitant use of benzodiazepines with the exception of PRN use of diazepam 10 mg/day or its equivalent
• Presence of serious and/or unstable medical condition
• Score of 3 or 4 on the suicide item (item 3) of the Ham-D scale
• Known sensitivity of sertraline