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Which 'second-generation antidepressants' are most effective? According to a metaanalysis in the February 28 issue of the Lancet, the two best of 12 new-generation antidepressants, as determined by clinical effectiveness (at least a 50% reduction in symptoms after eight weeks) and patient acceptability (low dropout rates), were sertraline and escitalopram, and the worst was reboxetine. Venlafaxine and mirtazapine also ranked high, but only on effectiveness, as did bupropion and citalopram, but only on patient tolerability. Because sertraline and escitalopram excelled at both efficacy and acceptability, they may be "the best choice when starting a treatment" for moderate-to-severe major depression, write the authors. The metaanalysis included 117 head-to-head randomized trials of nearly 26,000 patients, and no pharmaceutical companies were involved.