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Objective: Few controlled studies have addressed the issue of which antidepressant medications should be recommended for outpatients who have not responded to multiple treatment trials. Results: For mirtazapine, remission rates were For nortriptyline, remission rates were Major depressive disorder is associated with substantial morbidity, mortality, family burden, and health care costs 1. Consequently, a large majority of patients will warrant subsequent treatment regimens in order to achieve remission. Only one trial has included participants who had not received adequate benefit from two initial antidepressant treatments who were then randomly assigned to at least two potentially effective third-step treatments venlafaxine or paroxetine.
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