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For our next Quick Take, here’s a question for you. Suppose you have prescribed fluoxetine 20 mg for a patient with depression, an adult, and around 4 weeks later, she’s not better. Should you wait longer, or while waiting increase the dose to 30 mg or 40 mg? Nearly everyone I know would consider that dose increase at that point. But now comes a meta-analysis suggesting that there is no benefit in increasing the dose. You know, it’s surprising, since we face this all the time, how rarely this has been studied and almost not at all studied directly. But a new meta-analysis by Lena Rink and her colleagues from Germany in 2018, published in the Journal of Clinical Psychiatry , found 9 clinical trials where some patients were continued on their original dose while a random subset had their dose increased. So, does increasing the dose lead to a
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