Comparison between a serotonin and a noradrenaline reuptake blocker in the treatment of depressed outpatients

Seventy-five outpatients with major depressive disorder (RDC) were randomly referred to treatment with a dominant serotonin (5-HT) reuptake blocker (zimeldine, 100 mg, b.i.d. n = 40) or a dominant noradrenaline (NA) reuptake blocker (maprotiline, 75 mg, b.i.d. n = 35). Seven patients on each drug were non-responders after up to 4 weeks of treatment and were after a washout week crossed over to the other drug for up to another 8 weeks of treatment. There was a significant and similar improvement after 4 weeks of treatment with the second drug. After up to 8 weeks of treatment all patients but one in each group were much improved with the second drug. The existence of two biochemical subgroups of depression is discussed.