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We investigated the plasma levels of 3-methoxy-4-hydroxyglycol (MHPG) in patients who failed to paroxetine treatment and switched to milnacipran. The aim of the present study is to predict responders to serotonin noradrenaline reuptake inhibitor (SNR) who were resistant to selective serotonin reuptake inhibitor (SSRI) based on the plasma MHPG levels.