| Level 1 (initial treatment)16 |
| Citalopram (Celexa) | 47 | 28 to 33 | — |
| Level 2 (failed or did not tolerate level 1 treatment)11,14,17 |
| Citalopram plus CBT | 35‡ | 23 to 31‡ | Slower time to remission compared with augmentation of citalopram with buspirone (Buspar) or sustained-release bupropion (Wellbutrin SR) |
| Bupropion plus citalopram | 32‡ | 30 to 39‡ | Greater reduction in symptoms and fewer adverse effects than buspirone |
| Venlafaxine, extended-release (Effexor XR) | 28‡ | 25‡ | — |
| Buspirone plus citalopram | 27‡ | 30 to 33‡ | — |
| Sertraline (Zoloft) | 27‡ | 18 to 27‡ | — |
| Bupropion, sustained-release | 26‡ | 21 to 25‡ | — |
| CBT | 22‡ | 25 to 31‡ | Fewer adverse effects than pharmacotherapy |
| Level 3 (failed or did not tolerate level 2 treatment)18,19 |
| Augmentation with triiodothyronine§ | 23‡ | 25‡ | Fewer adverse effects than lithium |
| Augmentation with lithium‖ | 16‡ | 13 to 16‡ | — |
| Nortriptyline (Pamelor) | 16‡ | 12 to 20‡ | Tolerability similar to mirtazapine (Remeron) |
| Mirtazapine | 13‡ | 8 to 12‡ | — |
| Level 4 (failed or did not tolerate level 3 treatment)20 |
| Venlafaxine, extended-release, plus mirtazapine | 23‡ | 14 to 16‡ | Greater reduction in symptoms and fewer adverse effects than tranylcypromine (Parnate) |
| Tranylcypromine | 12‡ | 7 to 14‡ | — |