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Mirtazapine and nortriptyline similarly effective third-line treatments for depression

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 Q Is mirtazapine after two failed drug regimens more effective for treating depression than nortriptyline?

METHODS

Embedded ImageDesign:

Randomised controlled trial (RCT).

Embedded ImageAllocation:

Unclear.

Embedded ImageBlinding:

Single blind (assessors blinded).

Embedded ImageFollow up period:

Fourteen weeks (treatment period only).

Embedded ImageSetting:

Eighteen primary practices and 23 psychiatric practices in Maryland, USA: enrolment 2001 to 2004.

Embedded ImagePatients:

235 outpatients with a primary diagnosis of DSM-IV non-psychotic major depressive disorder on entry to the STAR*D study, who did not achieve an adequate response (Quick Inventory of Depressive Symptomatology (QIDS-SR16) score ⩽5) or could not tolerate two previous drug regimens delivered in the first two phases of this RCT. Exclusions: primary diagnosis of obsessive compulsive or eating disorders; bipolar or psychotic disorders; conditions contraindicating the use of antidepressive medication; substance abuse needing hospitalisation for detoxification; prior non-response to antidepressive medication; pregnancy, or breastfeeding.

Embedded ImageIntervention:

Mirtazapine (15 mg/day titrated up to a maximum of 60 mg/day) or nortriptyline (25 mg/day titrated up to a maximum of 150 mg/day). Recommended dosage regimens were provided but these were flexible to …

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