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Efficacy and tolerability of venlafaxine compared with selective serotonin reuptake inhibitors and other antidepressants: A meta-analysis

  • David Smith (a1), Carrie Dempster (a2), Julie Glanville (a3), Nick Freemantle (a4) and Ian Anderson (a5)...

Abstract

Background

In individual studies and limited meta-analyses venlafaxine has been reported to be more effective than comparator antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs).

Aims

To perform a systematic review of all such studies.

Method

We conducted a systematic review of double-blind, randomised trials comparing venlafaxine with alternative antidepressants in the treatment of depression. The primary outcome was the difference in final depression rating scale value, expressed as a standardised effect size. Secondary outcomes were response rate, remission rate and tolerability.

Results

A total of 32 randomised trials were included. Venlafaxine was more effective than other antidepressants (standardised effect size was −0.14, 95% Cl −0.07 to −0.22). A similar significant advantage was found against SSRIs (20 studies) but nottricyclic antidepressants (7 studies).

Conclusions

Venlafaxine has greater efficacy than SSRIs although there is uncertainty in comparison with other antidepressants. Further studies are required to determine the clinical importance of this finding.

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Copyright

Corresponding author

Nick Freemantle, Department of Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. Tel: +44(0)121 414 7943; fax: +44(0)121 414 6571; e-mail: N. Freemantle@bham.ac.uk

Footnotes

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The Editor, Greg Wilkinson, is in receipt of a consultancy fee from Neurolink (sponsored by Wyeth) so took no part in, and was kept blind to, the assessment of this paper. After enquiries by Professor Wilkinson, neither the Editorial Board member who acted as Editor in respect of this paper, nor those assessors who took part in the peer-review process, declared any interest relevant to the publication of this paper.

Declaration of interest

The study was funded by Wyeth Laboratories. D. S. has received funding on another study from Wyeth Laboratories and N. F. and I. A. have received speaker's fees and honoraria in connection with this work.

Footnotes

References

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Abdelmawla, A. Langley, R. Szabadi, E. et al (1999) Comparison of the effects of venlafaxine, desipramine and paroxetine on noradrenalin and methoxamine evoked constriction of the dorsal hand vein. British Journal of Clinical Pharmacology, 48, 345354.
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM–IV). Washington, DC: APA.
Anderson, I. M. (2000) Selective serotonin reuptake inhibitors versus tricyclic antidepressants: a meta-analysis of efficacy and tolerability. Journal of Affective Disorders, 58, 1936.
Anderson, I. M. Nutt, D. J. & Deakin, J. F. W. (2000) Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 1993 British Association for Psychopharmacology guidelines. Journal of Psychopharmacology, 14, 320.
Barbui, C. & Hotopf, M. (2001) Amitriptyline v. the rest: still the leading antidepressant after 40 years of randomised controlled trials. British Journal of Psychiatry, 178, 129144.
Cornwall, P. & Scott, J. (1997) Partial remission in depressive disorders. Acta Psychiatrica Scandinavica, 95, 265271.
DerSimonian, R. & Laird, N. (1986) Meta-analysis in clinical trials. Controlled Clinical Trials, 7, 177188.
Eccles, M. Freemantle, N. & Mason, J. (2000) The choice of antidepressants for depression in primary care. Family Practice, 16, 103111.
Edwards, G. (1992) Selective serotonin reuptake inhibitors: a modest though welcome advance in the treatment of depression. BMJ, 304, 16441645.
Ferrier, N. (1999) Treatment of major depression: is improvement enough? Journal of Clinical Psychiatry, 60 (suppl. 6), 1014.
Freemantle, N. Cleland, J. Young, P. et al (1999) What is the current place of β-blockade in secondary prevention alter myocardial infarction? A systematic overview and meta regression analysis. BMJ, 318, 17301737.
Freemantle, N. Anderson, I. M. & Young, P. (2000) Predictive value of pharmacological activity for the relative efficacy of antidepressant drugs. Meta-regression analysis. British Journal of Psychiatry, 177, 292302.
Geddes, J. R. Freemantle, N. Mason, J. et al (2001) SSRIs versus alternative antidepressants for depressive disorders. Cochrane Library, issue I. Oxford: Update Software.
Gross, G. & Huber, G. (1999) How far are newer antidepressants an advance compared with classical antidepressants? Neurology, Psychiatry and Brain Research, 7, 7986.
Guy, W. (1976) ECDEU Assessment Manual for Psychopharmacology. Revised DHEW Pub. (ADM). Rockville, MD: National Institute for Mental Health.
Hamilton, M. (1960) A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 5662.
Heninger, G. Delgado, P. & Charney, D. (1996) The revised monoamine theory of depression: a modulatory role of monoamines, based on new findings from monomaine depletion experiments in humans. Pharmacopsychiatry, 29, 211.
Holliday, S. M. & Benfield, P. (1995) Venlafaxine. A review of its pharmacology and therapeutic potential in depression. Drugs, 49, 280294.
Kelsey, J. (1996) Dose–response relationship with venlafaxine. Journal of Clinical Psychopharmacology, 16 (suppl. 2), 21S26S.
Montgomery, S. A. & Åsberg, M. (1979) A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382389.
Murray, C. & Lopez, A. (1997) Global mortality, disability, and the contribution of risk factors: global burden of disease study. Lancet, 349, 14361442.
Nelson, J. Mazure, C. Bowers, M. et al (1991) A preliminary, open study of the combination of fluoxetine and desipramine for rapid treatment of major depression. Archives of General Psychiatry, 48, 303307.
Owens, M. Morgan, W. Plott, S. et al (1997) Neurotransmitter receptor and transporter binding profile of antidepressants and their metabolites. Journal of Pharmacological Experimental Therapies, 283, 13051322.
Rudolph, R. Fabre, L. Feighner, J. et al (1998) A randomised, placebo-controlled, dose–response trial of venlafaxine hydrochloride in the treatment of major depression. Clinical Psychiatry, 59, 116122.
Seth, R. Jennings, A. L. Bindman, J. et al (1992) Combination treatment of noradrenalin and serotonin reuptake inhibitors in resistant depression. British Journal of Psychiatry, 161, 562565.
Smith, T. Spiegelhalter, D. & Thomas, A. (1995) Bayesian approaches to random-effects meta-analysis: acomparative study. Statistics in Medicine, 14, 26852699.
Stewart, L. A. & Parmar, M. K. B. (1996) Bias in the analysis and reporting of r andomized controlled trials. International Journal of Technology Assessment in Health Care, 12, 264275.
Tatsumi, M. Groshan, K. Blakely, R. et al (1997) Pharmacological profile of antidepressants and related compounds at human monoamine transporters. European Journal of Pharmacology, 340, 249258.
Thase, M. E. Entsuah, A. R. & Rudolph, R. L. (2001) Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors. British Journal of Psychiatry, 178, 234241.

Efficacy and tolerability of venlafaxine compared with selective serotonin reuptake inhibitors and other antidepressants: A meta-analysis

  • David Smith (a1), Carrie Dempster (a2), Julie Glanville (a3), Nick Freemantle (a4) and Ian Anderson (a5)...

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