Comparing how well older and newer antidepressants work for major depression with strong physical symptoms

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.

Simplified