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More people with depression continued treatment with fluoxetine than with desipramine or imipramine

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 QUESTION: In patients with depression, does initial treatment with fluoxetine improve clinical, quality of life, and economic outcomes better than desipramine or imipramine?


Randomised (allocation concealed*), unblinded,* controlled trial with 24 month follow up.


Primary care clinics in a health maintenance organisation in Seattle, Washington, USA.


536 patients (median age 41 y, 72% women) who were beginning antidepressant drug treatment. Exclusion criteria were use of antidepressant drugs in the previous 90 days, alcohol abuse, psychotic symptoms, history of mania, recent use of lithium or antipsychotics, or contraindication to the study drug. Follow up was 81% at 12 months and 72% at 24 months.


Patients were allocated to {fluoxetine (n=173), desipramine (n=181), or imipramine (n=182)}.

Main outcome measures.

Continuing use of initial medication; remission of depression; change in Hamilton Depression Rating Scale …

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  • Source of funding: Lilly Research Laboratories.

  • For correspondence: Dr G E Simon, Center for Health Studies, Group Health Cooperative, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101-1448, USA. Fax +1 206 287 2871.

  • A modified version of the abstract and commentary also appears in Evidence- Based Mental Health.

  • * See glossary.

  • Simon GE, VonKorff M, Heiligenstein JH, et al. JAMA. 1996;275:1897–902.