Serotonin–norepinephrine reuptake inhibitors (SNRIs) are commonly used as second-line agents when remission is not obtained with SSRIs. In small studies, venlafaxine did not show greater efficacy than placebo, but a larger, placebo-controlled trial of duloxetine showed significant improvements in late-life depression (response rate, 37% vs. 19%; remission rate, 27% vs. 15%). As observed in trials involving younger adults, randomized trials involving older adults have not
shown significant differences between the ben-efits of SSRIs and those of SNRIs, although ad-verse effects may be more frequent with SNRIs.