SNRIs in the management of acute major depressive disorder

Remission of a patient's index major depressive episode is essential in preventing a recurrent or chronic depressive course. Once remission is established, the subsequent goal is to maintain remission and prevent a relapse of the episode with a minimum of 4 to 9 months of continuation treatment. Common belief suggests that all antidepressants have equivalent efficacy when measured by remission, but this may be a misconception based on limitations in current clinical trial methods. Furthermore, major depressive disorder (MDD) is a complex illness with a variety of co-occurring somatic and often painful symptoms. In addition, increasing evidence suggests that, in some depressed patients, serotonin-norepinephrine reuptake inhibitors (SNRIs) may provide benefits of treating a broader range of target symptoms than single-acting agents, such as selective serotonin reuptake inhibitors (SSRIs). Given the available evidence and the importance of remission, the pendulum has swung to consider using agents with dual reuptake inhibition (e.g., SNRIs) as standard and initial treatment for depression.