Dualdual action? Combining venlafaxine and mirtazapine in the treatment of depression

Objective: Venlafaxine and mirtazapine in combination are increasingly used in clinical practice to treat treatment-refractory depression. Putative efficacy for this combination of antidepressants, beyond that of monotherapy, stems from their synergistic actions. This paper describes a prospective case series that examined the efficacy of the venlafaxine mirtazapine combination in the treatment of depressed patients who had failed at least one antidepressant trial. Method: Twenty-two depressed patients with major depression were treated with venlafaxine and mirtazapine in combination for an average of just under 8 weeks. Baseline ratings on the 17-item Hamilton Depression Rating Scale (HAM-D17), MontgomeryÅsberg Depression Rating Scale (MADRS) and the Clinical Global ImpressionSeverity Scale (CGI-S) were repeated at end-point, determined by the naturalistic termination of the depressive treatment episode or the discontinuation of the combination treatment due to adverse effects. The length of treatment until end-point was documented for each patient. Descriptive statistics were used on the collated data. Results: At baseline, mean scores were 28.8 (SD3.8) for HAM-D17, 30.1 (SD5.8) fo