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Antidepressants that affect more than one neurotransmitter system have been touted as more likely than SSRIs to produce remission. These investigators conducted a meta-analysis of data from 93 randomized, controlled studies comparing an SSRI (fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram, or escitalopram) with a “dual-action” agent (venlafaxine, duloxetine, mirtazapine, milnacipran, moclobemide, or mianserin; the latter three are not available in the U.S.).
The trials involved 17,036 patients and 101 drug comparisons. In a pooled analysis, response (defined as ≥50% decrease in depression-symptom scores) was marginally more likely with the dual-action agents (except duloxetine) than with SSRIs (relative risk, 1.06). The research…