Antidepressant effectiveness in severe depression and melancholic depression

Remission rates in short-term trials of newer antidepressants for severe depression are relatively low.

• Conflicting reports exist regarding the efficacy of newer antidepressants compared to older tricyclic antidepressants in severe depression.
• A standardized definition of severe depression is currently lacking, complicating the evaluation of treatment studies.
• Short-term clinical trials of newer antidepressants show low remission rates for severely depressed patients.
• Longer trial durations and aggressive dosing may improve remission rates in severe depression.
• Venlafaxine, a serotonin-norepinephrine antidepressant, may provide some benefit for severely depressed patients.

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