They are same kind of antidepressants called SSRI. n choosing a new antidepressant for patients who fail a selective serotonin reuptake inhibitor (SSRI), our general order of preference is serotonin-norepinephrine reuptake inhibitors, atypical antidepressants, tricyclics, and monoamine oxidase inhibitors. For patients with mild to moderate major depression who obtain little symptom relief despite repeated (eg, one to three) antidepressant switches, we suggest augmentation with a second medication and/or psychotherapy as second-line treatment, rather than additional trials of antidepressant monotherapy. In choosing an adjunctive drug, our general order of preference is second-generation antipsychotics, lithium, triiodothyronine, and a second antidepressant from a different class. However, it is reasonable to use these drugs in a different sequence. Among second-generation antipsychotics, our general order of preference is aripiprazole, quetiapine, risperidone, and olanzapine.
Patients with mild to moderate major depression who obtain definite symptom relief that is not satisfactory despite augmentation with different drugs (eg, two to four) should switch antidepressants as second-line treatment. Patients who do not respond satisfactorily to several (eg, three to nine) courses of first- and second-line treatments should receive repetitive transcranial magnetic stimulation as third-line treatment.
For patients with treatment resistant depression that is mild to moderate and is not responsive to first-, second-, and third-line treatments, other augmentation options include omega-3 fatty acids, folate, S-adenosyl methionine, or pramipexole.
Although electroconvulsive therapy (ECT) is usually reserved for severely depressed patients, it is a reasonable option for patients with moderate depression who are resistant to first-, second-, and third-line treatments.