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Compared with fluoxetine monotherapy, mirtazapine plus venlafaxine or fluoxetine increase remission but not response in patients with major depressive disorder

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Do mirtazapine-based combinations of antidepressants increase remission of major depressive disorder compared with fluoxetine monotherapy?


One hundred and five adults meeting DSM-IV criteria for major depressive disorder (MDD), and with 17-item Hamilton Depression Rating Scale (HAM-D) score ≥18. Individuals who did not respond to fluoxetine in their index episode were excluded.


Two university sites and an associated clinic in the USA and Canada; time period not stated.


Fluoxetine monotherapy (20mg/day) was compared with fluoxetine, extended release venlafaxine (225mg/day titrated in 14 days) or bupropion (150mg/day) in combination with mirtazapine (30mg/day) for six weeks. Branded formulations of fluoxetine, extended release venlafaxine and mirtazapine were used, and a slow release capsule formulation of bupropion was prepared. After the initial six weeks, participants could enter a six-month prolongation period if they reached a score of 12 or less on the Montgomery-Åsberg Depression Rating Scale (MADRS). In this period the fluoxetine monotherapy group continued their treatment, the fluoxetine plus mirtazapine group discontinued mirtazapine abruptly, the venlafaxine …

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