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Pharmacy Clinical Policy Bulletins

Subject: Antidepressants

Class Edit Summary*
Status Drug PR PR-QL PR-AL ST M EX‡
Selective Serotonin Reuptake Inhibitors (SSRIs)
P citalopram   X      
P fluoxetine   X      
P fluvoxamine   X      
P paroxetine   X      
P sertraline   X      
P Paxil CR® (paroxetine SR)       X X
FE Celexa® (citalopram)   X   X X
FE Lexapro® (escitalopram)   X   X X
FE Paxil® (paroxetine)   X   X X
FE Pexeva® (paroxetine)   X   X X
FE Prozac® (fluoxetine)   X   X X
FE Prozac® Weekly (fluoxetine)   X   X X
FE Rapiflux® (fluoxetine)   X   X X
FE Zoloft® (sertraline)   X   X X
Selective Norepinephrine Reuptake Inhibitors (SNRIs)
P Effexor XR® (venlafaxine SR)   X   X X
FE Cymbalta® (duloxetine) X X   X X
FE Effexor® (venlafaxine)   X   X X
Tricyclic Antidepressants
P amitriptyline          
P amoxapine          
P clomipramine          
P desipramine          
P doxepin          
P imipramine          
P nortriptyline          
P protriptyline          
NP Anafranil® (clomipramaine)          
NP Asendin® (amoxapine)          
NP Aventil® (nortriptyline)          
NP Elavil® (amitriptyline)          
NP Norpramine® (desipramine)          
NP Pamelor® (nortriptyline)          
NP Sinequan® (doxepin)          
NP Surmontil® (trimipramine)          
NP Tofranil® (imipramine)          
NP Vivactil® (protriptyline)          
Tretracyclic Antidepressants
P maprotiline   X      
P mirtazapine          
NP Ludiomil® (maprotiline)          
NP Remeron® /Solutab (mirtazapine)       X X
Miscellaneous Antidepressants
P budeprion   X      
P bupropion, bupropion SR   X      
P trazodone          
P Wellbutrin XL® (bupropion SR)   X   X X
NP Desyrel® (trazodone)     X X
FE nefazodone       X X
FE Emsam® (selegiline td patch 24-Hr)         X
FE Serzone® (nefazodone)       X X
FE Trazamine Pak® (trazodone tab/nutritional supp cap pack)         X
FE Wellbutrin® (bupropion)   X   X X
FE Wellbutrin SR® (bupropion SR)   X   X X
Monoamine Oxidase Inhibitors
NP Marplan®(isocarboxazid)          
NP Nardil®(phenelzine)          
NP Parnate®(tranylcypromine)          

*P = Preferred; FE = Formulary Excluded; NP = Nonpreferred
PR = Precertification; QL = Quantity Limits; AL = Age Limits; ST = Step-Therapy
‡M EX = Medical Exception - This means the physician or health care professional must obtain a medical exception from Aetna, in order for the medication to be eligible for coverage. Medical Exception criteria apply to Formulary Excluded drugs for members enrolled in or covered by closed benefits plans, and also apply to Step-Therapy drugs in cases where a member's physician believes it is medically necessary for the member to use a step-therapy drug in the first instance without a trial of the prerequisite alternative drug(s).

Important Note

This Pharmacy Clinical Policy Bulletin expresses Aetna's determination of whether certain services or supplies are medically necessary. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information. Each benefits plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their health care providers will need to consult the member's benefits plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (that is, will be paid for by Aetna) for a particular member. The member's benefits plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. In addition, coverage may be mandated by applicable legal requirements of a state, the federal government or CMS for Medicare and Medicaid members. CMS's Coverage Database can be found on the following website: http://www.cms.hhs.gov/center/coverage.asp.

Policy

  1. Precertification Criteria

    Under some plans, including plans that use an open or closed formulary, certain antidepressants are subject to precertification as specifically described below.

    • Cymbalta is subject to precertification. If precertification requirements apply, Aetna considers Cymbalta to be medically necessary for those members who meet the following precertification criteria:

      A documented diagnosis of one of the following:
         Cymbalta: major depressive disorder OR diabetic peripheral neuropathic pain

    • Bupropion, bupropion SR, citalopram, fluoxetine, fluvoxamine, maprotiline, paroxetine, sertraline, Celexa, Cymbalta, Effexor, Effexor XR, Lexapro, Paxil, Pexeva, Prozac, Prozac Weekly, Rapiflux, Wellbutrin, Wellbutrin SR, Wellbutrin XL and Zoloft may be subject to quantity limits.

      According to the manufacturers, these antidepressants can be dosed up to a maximum daily dose at the interval(s) as indicated in the table below. A quantity of each drug will be considered medically necessary as indicated in the table below; for Cymbalta, the member must also fulfill criteria A above.


    Drug Maximum DAILY Dose per Package Insert Doses per day Dosage Strengths Quantity Limits
    bupropion
    Wellbutrin    		 450 mg Three 75 mg, 100 mg Up to 180 tablets in 30 days
    bupropion SR
    Wellbutrin SR
    budeprion     		400 mg One or two 100, 150, 200 mg Up to 60 tablets in 30 days
    Wellbutrin XL 450 mg One 150 mg Up to 30 tablets in 30 days
    Wellbutrin XL 450 mg One 300 mg Up to 30 tablets in 30 days
    citalopram
    Celexa     		40 mg One 10, 20, 40 mg Up to 30 tablets in 30 days
    Cymbalta 60 mg One or two 20 mg, 30 mg Up to 60 capsules in 30 days
    Cymbalta 60 mg One or two 60 mg Up to 30 capsules in 30 days
    Effexor 375 mg Two or three 25mg, 100 mg Up to 90 tablets in 30 days
    Effexor 375 mg Two or three 37.5 mg Up to 120 tablets in 30 days
    Effexor 375 mg Two or three 50 mg Up to 180 tablets in 30 days
    Effexor 375 mg Two or three 75 mg Up to 150 tablets in 30 days
    Effexor XR 375 mg One 37.5 , 75 mg Up to 30 capsules in 30 days
    Effexor XR 375 mg Two 150 mg Up to 60 capsules in 30 days
    fluoxetine
    Prozac    		 80 mg One or two 10 mg Up to 30 tablets or capsules in 30 days
    fluoxetine
    Prozac    		 80 mg One or two 40 mg Up to 60 capsules in 30 days
    fluoxetine
    Prozac    		 80 mg One or two 20 mg capsules Up to 120 capsules in 30 days
    fluoxetine
    Rapiflux     		80 mg One or two 20 mg tablets Up to 30 tablets in 30 days
    fluoxetine
    Prozac    		 80 mg One or two Liquid 20 mg/5ml Up to 300 ml in 30 days (10ml/day)
    Prozac Weekly 90 mg One weekly 90 mg Up to 4 capsules in 28 days
    fluvoxamine 300 mg One or two 25 mg, 50 mg Up to 30 tablets in 30 days
    fluvoxamine 300 mg One or two 100 mg Up to 90 tablets in 30 days
    Lexapro 20 mg One 5, 10, 20 mg Up to 30 tablets in 30 days
    Lexapro 20 mg One Solution 5mg/5ml Up to 600 ml in 30 days
    maprotiline 225 mg One, or can be divided 25 mg Up to 30 tablets in 30 days
    maprotiline 225 mg One, or can be divided 50 mg Up to 60 tablets in 30 days
    maprotiline 225 mg One, or can be divided 75 mg Up to 90 tablets in 30 days
    paroxetine
    Paxil, Pexeva    		 60 mg One 10 mg, 20 mg Up to 30 tablets in 30 days
    paroxetine
    Paxil, Pexeva    		 60 mg One 30 mg, 40 mg Up to 60 tablets in 30 days
    paroxetine
    Paxil, Pexeva    		 60 mg One Suspension 10mg/5ml Up to 900 ml in 30 days
    sertraline Zoloft 200 mg One 25 mg Up to 30 tablets in 30 days
    sertraline Zoloft 200 mg One 50 mg Up to 45 tablets in 30 days
    sertraline Zoloft 200 mg One 100 mg Up to 60 tablets in 30 days
    sertraline Zoloft 200 mg One Liquid 20mg/ml Up to 300 ml in 30 days

    For coverage of additional quantities, a member's treating physician must request prior authorization through the Pharmacy Management Precertification Unit. A prior authorization will be granted for coverage of additional quantities of these antidepressants for those members who meet ANY of the following criteria:

    • Member requires a dose including half tablets OR
    • Member's dose is being titrated by physician (3-month limit) OR
    • Member has had intolerance to drug administered as a single daily dose OR
    • Member's physician provides documentation (controlled clinical trial) from the peer-reviewed medical literature for use of a higher dose.

  2. Step-Therapy Criteria

    Under some plans, including plans that use an open or closed formulary, Celexa, Cymbalta, Desyrel, Effexor, Effexor XR, Lexapro, nefazodone, Paxil, Paxil CR, Pexeva, Prozac, Prozac Weekly, Rapiflux, Remeron, Remeron solutab, Serzone, Wellbutrin, Wellbutrin SR, Wellbutrin XL and Zoloft are subject to step-therapy. Aetna considers these drugs to be medically necessary for those members who meet the following step-therapy criterion:

    A documented trial of one month of one of budeprion, bupropion, bupropion SR, citalopram, fluoxetine, fluvoxamine, paroxetine, mirtazapine, sertraline or trazodone - alternatives on the Preferred Drug List.

    If it is medically necessary for a member to be treated initially with a medication subject to step-therapy, the member's treating physician may contact the Aetna Pharmacy Management Precertification Unit to request coverage as a medical exception at 1-800-414-2386. (See criteria under section III below).

  3. Medical Exception Criteria

    Desyrel, Effexor XR, Paxil CR, Remeron, Remeron Solutab and Wellbutrin XL are currently listed on the Aetna Step-Therapy List.* If it is medically necessary for a member to be treated initially with one of these medications subject to step-therapy, Aetna considers these drugs to be medically necessary for those members who meet the criteria specified below.

    Celexa, Cymbalta, Effexor, Lexapro, nefazodone, Paxil, Pexeva, Prozac, Prozac Weekly, Rapiflux, Serzone, Wellbutrin, Wellbutrin SR and Zoloft are currently listed on the Aetna Formulary Exclusions and Step-Therapy lists.* Therefore, they are excluded from coverage for members enrolled in prescription drug benefit plans that use a closed formulary or that require step-therapy criteria, unless a medical exception is granted. Aetna considers these drugs to be medically necessary for those members who meet the criteria specified below:

    Emsam and Trazamine Pak are currently listed on the Aetna Formulary Exclusions list.* Therefore, they are excluded from coverage for members enrolled in prescription drug benefit plans that use a closed formulary, unless a medical exception is granted. Aetna considers Emsam and Trazamine Pak to be medically necessary for those members who meet the criteria specified below:

    For Celexa, Desyrel, Emsam, nefazodone, Paxil tablets, Pexeva, Prozac, Prozac Weekly, Rapiflux, Remeron, Remeron Solutab, Serzone, Wellbutrin and Wellbutrin SR:

    • A documented:
      • Intolerance to one generic preferred alternative - budeprion,bupropion, bupropion SR, citalopram, fluoxetine, fluvoxamine, paroxetine, mirtazapine, sertraline or trazodone OR
      • Contraindication to one generic preferred alternative - budeprion, bupropion, bupropion SR, citalopram, fluoxetine, fluvoxamine, paroxetine, mirtazapine, sertraline or trazodone OR
      • Allergy to one generic preferred alternative - budeprion ,bupropion, bupropion SR, citalopram, fluoxetine, fluvoxamine, paroxetine, mirtazapine, sertraline or trazodone OR
      • Failure of an adequate trial of one month of one generic preferred alternative - budeprion, bupropion, bupropion SR, citalopram, fluoxetine, fluvoxamine, paroxetine, mirtazapine, sertraline or trazodone.

    For Effexor, Lexapro, Paxil CR, Paxil suspension, Wellbutrin XL and Zoloft - A OR B (OR C for Paxil CR)

    • A documented:
      • Intolerance to one generic preferred alternative - budeprion ,bupropion, bupropion SR, citalopram, fluoxetine, fluvoxamine, paroxetine, mirtazapine, sertraline or trazodone OR
      • Contraindication to one generic preferred alternative - budeprion, bupropion, bupropion SR, citalopram, fluoxetine, fluvoxamine, paroxetine, mirtazapine, sertraline or trazodone OR
      • Allergy to one generic preferred alternative - budeprion ,bupropion, bupropion SR, citalopram, fluoxetine, fluvoxamine, paroxetine, mirtazapine, sertraline or trazodone OR
      • Failure of an adequate trial of one month of one generic preferred alternative - budeprion, bupropion, bupropion SR, citalopram, fluoxetine, fluvoxamine, paroxetine, mirtazapine, sertraline or trazodone.

      OR

    • Member is documented to be currently stabilized on one of these antidepressants: Effexor, Lexapro, Paxil CR, Paxil suspension, Wellbutrin XL.

      OR

    • Member has a documented diagnosis of premenstrual dysphoric disorder - for Paxil CR ONLY

    Member must have one of these symptoms in the week before menses (and symptoms improve when menses begins):

    • Very depressed mood, feeling hopeless
    • Marked anxiety, tension, edginess
    • Sudden mood shifts (crying easily, extreme sensitivity)
    • Persistent, marked irritability, anger, increased conflicts

    and at least 4 additional symptoms, from the list above or below:

    • Loss of interest in usual activities work, school, socializing
    • Difficulty concentrating and staying focused
    • Fatigue, tiredness, loss of energy
    • Marked appetite change, overeating, food cravings
    • Insomnia (difficulty sleeping) or sleeping too much
    • Feeling out of control or overwhelmed
    • Physical symptoms such as weight gain, bloating, breast tenderness or swelling, headache, and muscle or joint aches and pains

    For Cymbalta - (A AND B) OR C

    For Effexor XR - B OR C

    1. A Documented diagnosis of one of the following:
      Cymbalta: major depressive disorder OR diabetic peripheral neuropathic pain

      AND

    2. A documented:
      • Intolerance to one generic preferred alternative - budeprion ,bupropion, bupropion SR, citalopram, fluoxetine, fluvoxamine, paroxetine, mirtazapine, sertraline or trazodone OR
      • Contraindication to one generic preferred alternative - budeprion ,bupropion, bupropion SR, citalopram, fluoxetine, fluvoxamine, paroxetine, mirtazapine, sertraline or trazodone OR
      • Allergy to one generic preferred alternative - budeprion ,bupropion, bupropion SR, citalopram, fluoxetine, fluvoxamine, paroxetine, mirtazapine, sertraline or trazodone OR
      • Failure of an adequate trial of one month of one generic preferred alternative - budeprion, bupropion, bupropion SR, citalopram, fluoxetine, fluvoxamine, paroxetine, mirtazapine, sertraline or trazodone.

      OR

    3. Member is documented to be currently stabilized on one of these antidepressants: Cymbalta or Effexor XR.

    For Trazamine Pak

    1. A documented:
      • Intolerance to two generic preferred alternatives - budeprion ,bupropion, bupropion SR, citalopram, fluoxetine, fluvoxamine, paroxetine, mirtazapine, sertraline (one of which should be trazodone)OR
      • Contraindication to two generic preferred alternatives - budeprion ,bupropion, bupropion SR, citalopram, fluoxetine, fluvoxamine, paroxetine, mirtazapine, sertraline (one of which should be trazodone)OR
      • Allergy to two generic preferred alternatives - budeprion ,bupropion, bupropion SR, citalopram, fluoxetine, fluvoxamine, paroxetine, mirtazapine, sertraline (one of which should be trazodone) OR
      • Failure of an adequate trial of one month of two generic preferred alternatives - budeprion, bupropion, bupropion SR, citalopram, fluoxetine, fluvoxamine, paroxetine, mirtazapine, sertraline (one of which should be trazodone).

*Information regarding Aetna's Preferred Drug List, Formulary Exclusions list, Precertification and Step-Therapy lists is available on our website. In addition, members should refer to their plan documents and may call the toll-free telephone number on their ID card for information regarding their benefits. Health care professionals also may obtain information by calling the Pharmacy Management Precertification Unit at 1-800-414-2386, or they can register to use our password-protected provider website. Visit www.aetna.com, select "Doctors & Hospitals" and choose "Physician Self-Service." Once registration is completed, health care professionals may use our online Precertification/medical exception email request form.

The lists above are subject to change. Not all programs - for example step-therapy, precertification, and quantity limits - are available in all service areas (for example, step-therapy does not apply to fully insured New Jersey members).

Many medications on the Preferred Drug List are subject to manufacturer rebate arrangements between Aetna and the manufacturer of those medications. If the member's prescription benefits plan has a deductible or copay levels based on a percentage of Aetna's contracted rate with the participating pharmacy, the contracted rate does not include or reflect any manufacturer rebate arrangements between Aetna and the medication manufacturer. In prescription plans with a deductible or copayment or coinsurance tiers, use of drugs from the Preferred Drug List generally will result in lower costs to members. However, where the prescription plan utilizes a deductible or copayments or coinsurance calculated on a percentage basis, there could be some circumstances in which a preferred drug would cost the member more than a nonpreferred drug because (1) the negotiated pharmacy payment rate for the preferred drug may be more than the negotiated pharmacy payment rate for the nonpreferred drug, and (2) rebates received by Aetna from drug manufacturers are not reflected in the cost of a prescription drug obtained by a member. The Preferred Drug List is subject to change.

In evaluating clinically and therapeutically similar drugs for selection for the Preferred Drug List, Aetna reviews the costs of drugs and takes into account rebates negotiated between Aetna and drug manufacturers. Consequently, a drug may be included on the Preferred Drug list that is more expensive than a nonpreferred alternative before any rebates Aetna may receive from a drug manufacturer are taken into account. In addition, certain drugs may be chosen for "preferred" status because of their clinical or therapeutic advantages or level of acceptance among physicians even though they cost more than nonpreferred alternatives. The net cost to a self-funded plan sponsor for covered prescriptions will vary based on (1) the terms of Aetna's arrangements with participating pharmacies; (2) the amount of the member's copayment, coinsurance or deductible obligation under the terms of the plan; and (3) the percentage, if any, of rebates to which the plan sponsor is entitled under its agreement with Aetna. As a result, a self-funded plan sponsor's actual claim expense per prescription for a particular preferred drug may in some circumstances be higher than for a nonpreferred alternative.

For members in Texas, additions to the 2006 Preferred Drug List will be effective no later than January 1, 2006. In accordance with state law, fully insured members in Texas who are receiving coverage for medications that are removed from the Preferred Drug List during the plan year will continue to have those medications covered at the same benefit level until their plan's renewal date.

This definition of precertification is not the same as the definition used by Texas law. Our use of the term "precertification" relates to the prior authorization of your services by Aetna, based on our decision of whether the service is medically necessary. Precertification is not a guarantee of payment or "verification" as defined by Texas law.

California HMO members enrolled in a closed formulary benefits plan who are receiving coverage for medications that are moved to the Formulary Exclusions List, and California HMO members who are receiving coverage for medications added to the Precertification or Step-Therapy lists, will continue to have those medications covered, for as long as the treating physician continues prescribing them. This coverage, in accordance with state law, is only provided when the drug is appropriately prescribed and is considered safe and effective for treating the member's medical condition.

Nothing in this section shall preclude the prescribing health care professional from prescribing another drug covered by the plan that is medically appropriate for the enrollee, nor shall anything in this section be construed to prohibit generic drug substitutions.

Place of Service:

    Outpatient

Special Notes:

SSRI Use in Children
In the past decade, SSRIs have been increasingly used as first line treatment in children with depression. Recently, questions have been raised concerning the safety and efficacy of these agents in this population. Currently, fluoxetine is the only SSRI approved for treatment of major depressive disorder in children as young as 8 years of age. Fluoxetine and fluvoxamine are indicated for obsessive-compulsive disorder in children 8 years and older, and sertraline in children 6 years and older.

There are few robust studies suggesting the use of one SSRI over another considering the population to be studied. Fluoxetine is the oldest agent in this class and therefore, has the most experience associated with its use. It has demonstrated a favorable risk-benefit profile in studies with children down to age 752, 53. There is some evidence to suggest that paroxetine does not improve depressive symptoms and has an increased risk of suicidal ideation and/or suicide attempt54. In 2003, the FDA recommended that paroxetine not be used in children or adolescents for treatment of depression55. Sertraline and citalopram marginally improve depressive symptoms and may be associated with a slightly increased risk of suicide ideation and/or attempts56, 57.

With the exception of paroxetine, the other SSRIs mentioned above may be effective options for treating children with depression. Again, the literature currently available does not validate the use of one SSRI over another in the pediatric population. Additional, well-designed studies are warranted.

SSRI Use in Pregnancy and Lactation
SSRIs are effective in treating both antenatal and postpartum depression. However, benefit-risk assessments should be done before prescribing these agents. At this time, all SSRIs have a pregnancy risk factor C; evidence suggests that there may be a fetal risk for developmental toxicity in the 3rd trimester, or close to delivery58. However, in September 2005, the manufacturer of Paxil/Paxil CR and the FDA notified healthcare professionals of results of a retrospective epidemiologic study of major congenital malformations in infants born to women taking antidepressants during the first trimester of pregnancy. This study suggested an increase in the risk of overall major congenital malformations for paroxetine as compared to other antidepressants59. Fluoxetine is the most studied agent in pregnant women. There also does not appear to be an increased risk of major congenital malformations with the other SSRIs at this time; however, information on sertraline, fluvoxamine, escitalopram, and citalopram is limited60.

The risk of the different SSRIs in neonatal toxicity or withdrawal is not currently established. The FDA altered the warning labeling for all agents stating that newborns exposed to SSRIs in utero may experience symptoms that prolong hospitalization and require respiratory and nutritional support. Generally, these symptoms have been transient. Paroxetine may be associated with more SSRI-induced neonatal convulsions due to the fact that paroxetine metabolizes the fastest, with increased clearance from the body, resulting in a withdrawal effect.61

In lactation, sertraline and paroxetine has very little concentrations present in breast milk and nursing infants. Fluoxetine and citalopram have higher concentrations detected in nursing infants but do not appear to cause adverse effects58. Women can continue fluoxetine or citalopram if they were effective during pregnancy62.

The above policy is based on the following references:

  1. Hirschfeld R. Long-term side effects of SSRIs: Sexual dysfunction and weight gain. J Clin Psychiatry 2003;64 (suppl 18):20-4.
  2. Alvarez Jr W and Pickworth KK. Safety of antidepressant drugs in the patient with cardiac disease: A review of the literature. Pharmacotherapy. 2003;23(6):754-71.
  3. Golden RN, Nemeroff CB, McSorley P, et al. Efficacy and tolerability of controlled-release and immediate-release paroxetine in the treatment of depression. J Clin Psychiatry 2002;63:57-84.
  4. US Food and Drug Administration. Antidepressant use in children, adolescents, and adults. Issued March 23, 2004. Available at: http://www.fda.gov/cder/drug/antidepressants/default.htm. Accessed 4/7/2004.
  5. Clayton AH, Pradko JF, Croft HA, et al. Prevalence of sexual dysfunction among newer antidepressants. J Clin Psychiatry. 2002;63:357-66.
  6. Gregorian Jr RS, Golden KA, Bahce A, et al. Antidepressant-induced sexual dysfunction. Ann Pharmacother. 2002;36:1577-89.
  7. Lam RW, Wan DDC, Cohen NL, and Kennedy SH. Combining antidepressants for treatment-resistant depression: A review. J Clin Psychiatry. 2002;63:685-93.
  8. Hirschfeld RMA, Montgomery SA, Aguglia E, et al. Partial response and nonresponse to antidepressant therapy: Current approaches and treatment options. J Clin Psychiatry. 2002;63:826-37.
  9. Glassman AH, O'Connor CM, Califf RM, et al. Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA. 2002;288:701-9.
  10. Labbate LA, Croft HA, and Oleshansky MA. Antidepressant-related erectile dysfunction: Management via avoidance, switching antidepressants, antidotes, and adaptation. J Clin Psychiatry. 2003;64(suppl 10):11-19.
  11. van den Brink RHS, van Melle JP, Honig A, et al. Treatment of depression after myocardial infarction and the effects on cardiac prognosis and quality of life: Rationale and outline of the Myocardial Infarction and Depression-Intervention Trial (MIND-IT). Am Heart J. 2002;144:219-25.
  12. Kornstein SG. Chronic depression in women. J Clin Psychiatry. 2002;63:602-9.
  13. Brent DA and Birmaher B. Adolescent depression. N Engl J Med. 2002;347:667-71.
  14. Rush AJ, Trivedi M, Fava M. Depression, IV: STAR*D treatment trial for depression. Am J Psychiatry. 2003;160:237.
  15. Practice parameters for the assessment and treatment of children and adolescents with depressive disorders. J Am Acad Child Adolesc Psychiatry. 1998;37(10 Suppl):63S-83S
  16. Rosen RC and Humberto M. Prevalence of antidepressant-associated erectile dysfunction. J Clin Psychiatry. 2003;64(suppl 10):5-10.
  17. Rapaport MH, Schneider LS, Dunner DL, et al. Efficacy of controlled-release paroxetine in the treatment of late-life depression. J Clin Psychiatry. 2003;64:1065-74.
  18. Wagner KD, Ambrosini P, Rynn M, et al. Efficacy of sertraline in the treatment of children and adolescents with major depressive disorder. Two randomized controlled trials. JAMA. 2003;290:1033-41.
  19. MacGillivray S, Arroll B, Hatcher S, et al. Efficacy and tolerability of selective serotonin reuptake inhibitors compared with tricyclic antidepressants in depression treated in primary care: systematic review and meta-analysis. BMJ. 2003;326:1014-7
  20. Emslie GJ, Heiligenstein JH, Wagner KD, et al. Fluoxetine for acute treatment of depression in children and adolescents: a placebo-controlled, randomized clinical trial. J Am Acad Child Adolesc Psychiatry. 2002;41:1205-15.
  21. Souery D, Amsterdam J, de Montigny C, et al. Treatment resistant depression: methodological overview and operation criteria. Eur Neuropsychopharmacol 1999;9:83-91.
  22. Noble S and Benfield P. Citalopram. A review of its pharmacology, clinical efficacy and tolerability in the treatment of depression. CNS Drugs. 1997;8(5):410-31.
  23. Trivedi M, Kleiber B. Algorithm for the treatment of chronic depression. J Clin Psychiatry 2001;62(Suppl 6):22-9.
  24. Richelson E. Interactions of antidepressants with neurotransmitter transporters and receptors and their clinical relevance. J Clin Psychiatry. 2003;64(suppl 13):5-12.
  25. Sproule BA, Naranjo CA, Bremner KE, Hassan PC. Selective serotonin reuptake inhibitors and CNS drug interactions. Clin Pharmacokinet. 1997;33:454-71.
  26. Thase ME. Achieving remission and managing relapse in depression. J Clin Psychiatry 2003;64(suppl 18):3-7.
  27. Greenblatt DJ, von Moltke LL, Harmatz JS, Shader RI. Drug interactions with newer antidepressants: Role of human cytochromes P450. J Clin Psychiatry 1998:59(S 15)19-27.
  28. Segraves RT. Antidepressant-induced sexual dysfunction. J Clin Psychiatry 1998;59(Suppl 4):48-54.
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July 1, 2006