Achieving remission with venlafaxine and fluoxetine in major depression: its relationship to anxiety symptoms

Abstract

Venlafaxine, a serotonin and norepinephrine reuptake inhibitor (SNRI), produces significantly higher remission rates in depressed patients than do the selective serotonin reuptake inhibitors (SSRIs). In this analysis of pooled data, we explored the relationship between differences in treatment efficacy, early improvement of symptoms, and severity of baseline anxiety in depressed patients treated with either venlafaxine or fluoxetine. A pooled analysis was performed on data from 1,454 outpatients with major depression from five double-blind, randomized studies comparing the 6-week efficacy of venlafaxine (542 patients) with fluoxetine (555 patients). The Hamilton rating scale for depression (HAM-D) total and item scores were analyzed at different treatment times up to 6 weeks. Venlafaxine and fluoxetine both produced statistically significant higher response and remission rates compared with placebo starting from week 2 for response and weeks 3 to 4 for remission. Venlafaxine was statistically significantly superior to fluoxetine from week 3 until week 6 in respect of response rate, and from week 2 until week 6 for remission rate. After 1 week of treatment, greater improvement in individual symptoms was observed in the depressed mood, suicide, and psychic anxiety items of the HAM-D scale for both venlafaxine- and fluoxetine-treated patients compared with placebo. Improvement in psychic anxiety was statistically significantly greater with venlafaxine than with fluoxetine. The presence of baseline psychic anxiety correlated significantly to treatment outcome when analyzing the remission rates. In depressed patients with moderate anxiety (HAM-D psychic anxiety score < or = 2), venlafaxine statistically significantly increased remission rates compared with placebo from week 4 until week 6, while a significant effect of fluoxetine on remission rates was observed starting at week 6. Remission rates in the severely anxious depressed patients (score > 2) were statistically significantly higher with venlafaxine than placebo starting from week 3 until the end of the study period, but no difference could be observed between fluoxetine and placebo. Baseline severity of psychic anxiety had a significant impact on remission rates after treatment of patients diagnosed with depression. Venlafaxine's superior remission rates in the more severely anxious patients and its ability to improve psychic anxiety as early as week 1 compared with fluoxetine suggest that venlafaxine's early efficacy on anxiety symptoms may be the basis for its superior efficacy in depression.

Lurasidone for major depressive disorder with mixed features and anxiety: a post-hoc analysis of a randomized, placebo-controlled study

“…[2][3][4][5][6][7][8][9][10][11][12] In MDD patients without mixed features, the presence of concurrent anxiety has been shown to reduce the likelihood of achieving an adequate antidepressant response. [19][20][21][22][23][24][25][26][27] We report here the results of a post-hoc analysis of a placebo-controlled, 6-week trial of MDD presenting with mixed features and anxiety which found that treatment with lurasidone significantly improved depressive symptoms in a subgroup of patients with moderate-to-severe anxiety at baseline. Significant improvement was also noted in the subgroup with mild anxiety at baseline.…”

“…[19][20][21][22][23][24][25][26][27][28][29][30] Notably, treatment with lurasidone has previously demonstrated significant anxiolytic treatment effects in three separate 6-week trials in bipolar depression. [33][34][35] While further studies are necessary to confirm these findings, the results of the current analysis, taken together with the consistent improvements in HAM-A scores observed in prior bipolar depression studies, suggest that lurasidone may be a useful treatment for mixed forms of major depression associated with anxiety.…”

“…3,11 MDD with mixed features is also associated with higher severity of concurrent anxiety symptoms. [10][11][12] High levels of anxiety have frequently been reported to reduce the likelihood of achieving an adequate antidepressant response in patients with both unipolar MDD [19][20][21][22][23][24][25][26][27] and bipolar depression. [28][29][30] To our knowledge, no controlled trial to date has evaluated the potential impact of concurrent anxiety symptoms on response to treatment in patients presenting with MDD with mixed features.…”

Cognitive-Behavioural Therapy Combined with Antidepressants for Major Depressive Disorder

“…Its findings indicated that venlafaxine was superior to SSRIs (Smith et al, 2002). Another meta-analysis of five sixweek, double-blind, randomized studies including 1,454 outpatients with major depression from comparing the efficacy of venlafaxine with fluoxetine showed that venlafaxine was not www.intechopen.com only superior to but also had a more rapid onset of action than fluoxetine (Davidson et al, 2002). The rapid onset of remission for venlafaxine treatment over SSRIs does not differ in age or gender .…”

Treatment of endogenous depression with venflaxine: clinical action, tolerability and personalized treatment options

“…Многолетний успешный мировой опыт приме-нения венлафаксина свидетельствует об дозозави-симом механизме его действия, что дает возмож-ность использовать препарат в качестве альтерна-тивы СИОЗС и трициклическим антидепрессантам при лечении и терапевтически резистентных де-прессий, и остро развившейся первичной депрес-сии как в стационарной, так и амбулаторной прак-тике [7,[14][15][16][17][18][19]. Подчеркиваются благоприятный профиль переносимости и невысокая частота по-бочных эффектов в ходе терапии венлафаксином [14].…”