Effectiveness of Antidepressants: Comparative Remission Rates

Historically, clinical researchers have gauged the short-term effectiveness of antidepressants by responserates, which have been defined as a “significant” reduction of symptoms or a global impressionof at least moderate benefit. However, increased focus over the past decade has led many researchersto suggest that remission, i.e., a virtual elimination of depressive symptoms and restorationof psychosocial functioning, should be the primary goal of the initial phase of therapy. This articleexamines the relative efficacy of various antidepressant therapies. There is some evidence that medicationsaffecting multiple neurochemical systems, such as the tricyclics amitriptyline and clomipramine(in studies of hospitalized patients) and the more selective “dual reuptake inhibitor” venlafaxine,may result in higher rates of remission relative to other agents. Given the better tolerability of newerantidepressants relative to tricyclics, both logic and an increasing amount of data support a greaterrole for multiaction antidepressants.