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In the NIH-sponsored STAR*D trial, outpatients with major depression are taken through multiple levels of treatment until remission is achieved. Researchers have reported results from Level 1 (with citalopram monotherapy) and Level 2 (with bupropion, sertraline, or venlafaxine monotherapies, or with citalopram augmented by bupropion or buspirone; Journal Watch Apr 7 2006). Now, they report results from Level 3.
A total of 235 patients (mean age, 45) who did not achieve remission (or who couldn't tolerate the drugs) in Levels 1 and 2 were randomized to receive monotherapy with the atypical antidepressant mirtazapine (Remeron and generics) or the tricyclic nortriptyline. At 12 weeks, remission rates were 12% in the mirtazapine group and 20% in…