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Tranylcypromine versus venlafaxine plus mirtazapine following three failed antidepressant medication trials for depression: a STAR*D report.

Publication ,  Journal Article
McGrath, PJ; Stewart, JW; Fava, M; Trivedi, MH; Wisniewski, SR; Nierenberg, AA; Thase, ME; Davis, L; Biggs, MM; Shores-Wilson, K; Luther, JF ...
Published in: Am J Psychiatry
September 2006

OBJECTIVE: The purpose of this study was to compare the effectiveness and tolerability of tranylcypromine and combination treatment with extended-release venlafaxine and mirtazapine in patients with treatment-resistant major depression whose current depressive episode had not responded adequately to treatment in three prior prospective medication trials. METHOD: Adult outpatients with nonpsychotic major depressive disorder who had not achieved remission or had withdrawn from treatment because of intolerance in three previous prospective medication trials were randomly assigned to receive open-label treatment with either tranylcypromine (N=58) or extended-release venlafaxine plus mirtazapine (N=51). The primary outcome measure was whether patients achieved remission, which was defined as a score < or =7 at exit on the 17-item Hamilton Depression Rating Scale (HAM-D). The HAM-D was administered by telephone by raters to whom treatment was masked. RESULTS: Remission rates were not significantly different between the two treatment groups (6.9% for the tranylcypromine group and 13.7% for the venlafaxine plus mirtazapine group). The mean daily dose at exit for tranylcypromine was 36.9 mg (SD=18.5); for venlafaxine, 210.3 mg (SD=95.2); and for mirtazapine, 35.7 mg (SD=17.6). Tranylcypromine was associated with significantly less symptom reduction and greater attrition due to intolerance. CONCLUSIONS: Remission rates were modest for both the tranylcypromine group and the extended-release venlafaxine plus mirtazapine group, and the rates were not statistically different between groups. The lower side effect burden, lack of dietary restrictions, and ease of use of venlafaxine and mirtazapine suggest that this combination may be preferred over tranylcypromine for patients with highly treatment-resistant depression who have not benefited adequately from several prior treatments.

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Published In

Am J Psychiatry

DOI

ISSN

0002-953X

Publication Date

September 2006

Volume

163

Issue

9

Start / End Page

1531 / 1541

Location

United States

Related Subject Headings

  • Venlafaxine Hydrochloride
  • Treatment Outcome
  • Tranylcypromine
  • Psychiatry
  • Psychiatric Status Rating Scales
  • Mirtazapine
  • Middle Aged
  • Mianserin
  • Male
  • Interviews as Topic
 

Citation

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McGrath, P. J., Stewart, J. W., Fava, M., Trivedi, M. H., Wisniewski, S. R., Nierenberg, A. A., … Rush, A. J. (2006). Tranylcypromine versus venlafaxine plus mirtazapine following three failed antidepressant medication trials for depression: a STAR*D report. Am J Psychiatry, 163(9), 1531–1541. https://doi.org/10.1176/ajp.2006.163.9.1531
McGrath, Patrick J., Jonathan W. Stewart, Maurizio Fava, Madhukar H. Trivedi, Stephen R. Wisniewski, Andrew A. Nierenberg, Michael E. Thase, et al. “Tranylcypromine versus venlafaxine plus mirtazapine following three failed antidepressant medication trials for depression: a STAR*D report.Am J Psychiatry 163, no. 9 (September 2006): 1531–41. https://doi.org/10.1176/ajp.2006.163.9.1531.
McGrath PJ, Stewart JW, Fava M, Trivedi MH, Wisniewski SR, Nierenberg AA, et al. Tranylcypromine versus venlafaxine plus mirtazapine following three failed antidepressant medication trials for depression: a STAR*D report. Am J Psychiatry. 2006 Sep;163(9):1531–41.
McGrath, Patrick J., et al. “Tranylcypromine versus venlafaxine plus mirtazapine following three failed antidepressant medication trials for depression: a STAR*D report.Am J Psychiatry, vol. 163, no. 9, Sept. 2006, pp. 1531–41. Pubmed, doi:10.1176/ajp.2006.163.9.1531.
McGrath PJ, Stewart JW, Fava M, Trivedi MH, Wisniewski SR, Nierenberg AA, Thase ME, Davis L, Biggs MM, Shores-Wilson K, Luther JF, Niederehe G, Warden D, Rush AJ. Tranylcypromine versus venlafaxine plus mirtazapine following three failed antidepressant medication trials for depression: a STAR*D report. Am J Psychiatry. 2006 Sep;163(9):1531–1541.
Journal cover image

Published In

Am J Psychiatry

DOI

ISSN

0002-953X

Publication Date

September 2006

Volume

163

Issue

9

Start / End Page

1531 / 1541

Location

United States

Related Subject Headings

  • Venlafaxine Hydrochloride
  • Treatment Outcome
  • Tranylcypromine
  • Psychiatry
  • Psychiatric Status Rating Scales
  • Mirtazapine
  • Middle Aged
  • Mianserin
  • Male
  • Interviews as Topic