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Despite the unequivocal efficacy of newer antidepressants, the debate continues about whether they are as effective as tricyclics (TCAs) in severely depressed patients (see JW for Psychiatry 1995, vol. 1, p.1). This randomized study compared the efficacy of imipramine with recently-approved mirtazapine (Remeron) in 107 inpatients with Hamilton Rating Scale for Depression (Ham-D) scores of 18 or higher.
After one week of placebo, drug doses were adjusted to reach targeted blood levels. Since there is no established effective blood level for mirtazapine, as there is for imipramine, researchers chose average levels achieved with a 60 mg/day dose. After six weeks, 50% of imipramine recipients had a 50% reduction on the Ham-D versus 22% of mirtaz…