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Pharmacotherapy for major depression with melancholic features: relative efficacy of tricyclic versus selective serotonin reuptake inhibitor antidepressants
Comparing how well older and newer antidepressants work for major depression with strong physical symptoms
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Abstract
Tricyclic antidepressants (TCAs) are consistently more effective than selective serotonin reuptake inhibitors (SSRIs) in treating melancholic depression.
- Data from Hamilton Depression Rating reviews show a clear effectiveness advantage for TCAs over SSRIs in endogenous/melancholic depression.
- Despite their widespread use, SSRIs may not be the optimal first-line treatment for melancholic patients.
- Clinicians may consider prescribing TCAs as a first-line treatment for melancholic depression.
- For melancholic patients unresponsive to SSRIs, alternative treatments could include TCAs alone, TCA augmentation of SSRIs, or lithium augmentation of SSRIs.
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