Clinical recommendation	Evidence rating	References
Selective serotonin reuptake inhibitors are more likely than placebo to produce depression remission in the primary care population.	B	1
Serotonin-norepinephrine reuptake inhibitors are slightly more likely than selective serotonin reuptake inhibitors to improve depression symptoms, but they are associated with higher rates of adverse effects such as nausea and vomiting.	B	6, 41
For treatment-naive patients, all second-generation antidepressants are equally effective. Medication choice should be based on patient preferences, with adverse effect profiles, cost, and dosing frequency taken into consideration.	C	42
Antidepressants are most effective in patients with severe depression.	A	44–46
Preferred agents for older patients with depression include citalopram (Celexa), escitalopram (Lexapro), sertraline (Zoloft), mirtazapine (Remeron), venlafaxine, and bupropion (Wellbutrin). Because of higher rates of adverse effects in older adults, paroxetine (Paxil) and fluoxetine (Prozac) should generally be avoided.	C	50
Treatment for a first episode of major depression should last at least four months. Patients with recurrent depression may benefit from prolonged treatment.	C	42