Optimización versus “Switch” temprano en depresión monopolar: Revisión comprensiva acerca de una controversia clínica

Abstract

In the current management of monopolar depression, achieving functional recovery as early as possible is a challenge that today’s clinicians cannot evade, as the delay in symptom remission predicts a higher number of relapses and increased morbidity and mortality. Knowing how to choose, combine or sequence different psychopharmacological strategies, such as optimization or switching of an antidepressant are frequent questions in everyday clinical practice. This reflective review aims to elucidate when the clinician should optimize or switch an antidepressant treatment in a patient with a monopolar depressive episode that goes to a regular appointment after two to four weeks since the onset of treatment and reports partial response to the initially chosen drug. An adequate analysis of symptomatic domains, having a critical view of contemporary clinical guidelines, and maintaining an active but lucid approach at this early stage of treatment are, in our opinion, fundamental elements for the pursuit of an “ad integrum” recovery.