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ACP Offers Guidelines on Second-Generation Antidepressants
The American College of Physicians has released clinical practice guidelines on using second-generation antidepressants to treat the spectrum of depressive disorders in adults.
The guidelines, which appear in Annals of Internal Medicine, derive from an analysis of nearly 30 years' worth of published research on 12 drugs: bupropion, citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, sertraline, trazodone, and venlafaxine.
The principal recommendations follow:
-- Since all of the drugs are about equally effective, consider adverse-effect profiles, costs, and patient preferences when choosing among them.
-- Assess the patient's status regularly, beginning within 2 weeks after starting therapy.
-- Modify treatment if there's no response within 2 months.
-- Successful treatments of first episodes of major depression should continue for about 6 months; patients with a history of two or more episodes should undergo treatment for much longer periods.