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ACP treatment guideline for antidepressants
The American College of Physicians has issued a practice guideline for the use of antidepressants to treat depressive disorders. The guideline encompasses the use of newer "second-generation antidepressants," including the SSRIs: fluoxetine (Prozac®), sertraline (Zoloft®), paroxetine (Paxil®), citalopram (Celexa®), escitalopram (Lexapro®), and fluvoxamine (Luvox®). Also included were the SNRIs venlafaxine (Effexor®), and duloxetine (Cymbalta®), as well as other drugs such as mirtazapine (Remeron®), bupropion (Wellbutrin®), nefazodone, and trazadone. After reviewing 203 clinical trials, the guideline group concluded that there were no significant differences between the drugs with regard to efficacy. The guideline group recommends that second-generation antidepressants should be selected on the basis of adverse effect profiles, cost, and patient preference. They further recommend that clinicians should assess patient status, therapeutic response, and adverse effects of antidepressant therapy on a regular basis beginning within 1-2 weeks of initiation of therapy and that treatment should be modified if the patient does not have an adequate response to pharmacotherapy within 6-8 weeks. Finally, they recommend that clinicians continue treatment for 4-9 months after a satisfactory response in patients with a first episode of major depressive disorder. For patients with history of depression, a longer duration of therapy may be beneficial (Ann Intern Med 2008;149:725-733).