Medications
Step 3 comprised 1 capsule of fluoxetine, 20 mg per day, or placebo, increasing to 40 mg per day or 2 placebo capsules after 6 weeks if clinical response was insufficient as judged by the treating psychiatrist. At 12 weeks, a fast-fail option was available for participants who had deteriorated or had not responded to treatment. Through a shared decision-making process, participants chose to either continue as randomized, increase the fluoxetine or placebo dosage, or receive an add-on of low-dose antipsychotic medication (quetiapine, 50-300 mg per day, or aripiprazole, 10-30 mg per day) or long-chain ω-3 fatty acids (2.8 g per day of marine fish oil in 4 × 0.7-g capsules containing approximately 1.4 g eicosapentanoic and docosahexanoic acid).