Comparison of venlafaxine extended release versus paroxetine for treatment of patients with generalized anxiety disorder

Kim, Tae Suk; Pae, Chi Un; Yoon, Sujung; Bahk, Won Myong; Jun, Tae-Won; Rhee, Won Ihl; Chae, Jeong Ho

doi:10.1111/j.1440-1819.2006.01512.x

Cited by 30 publications

(16 citation statements)

References 11 publications

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“…In contrast to duloxetine, Tang et al reported that fluoxetine showed equivalent efficacy either on HAM-A scores’ reduction or response rate at the end of a 6-week trial 45. These results were consistent with several RCTs in Western countries that directly compared different SSRIs and SNRIs, in which no statistically significant difference was found between them 46,47. Although there is less available data, it implies that fluoxetine can also be utilized as an effective SSRI in treating GAD.…”

Section: Comparative Safety Tolerability and Efficacy Of Fluoxetinesupporting

confidence: 89%

Clinical efficacy and safety of fluoxetine in generalized anxiety disorder in Chinese patients

Zou¹,

Ding²,

Flaherty³

et al. 2013

NDT

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BackgroundGeneralized anxiety disorder (GAD) is a prevalent, disabling disease and is highly comorbid with other psychiatric disorders both in Western countries and the People’s Republic of China. Fluoxetine, a selective inhibitor of serotonin reuptake (SSRI), is widely utilized in the management of GAD in clinical practice despite the lack of strong evidence. This article reviews fluoxetine trials to investigate fluoxetine’s efficacy and tolerability in Chinese patients with GAD.MethodsA literature review was conducted using the following databases up to and including April 2013: Chinese BioMedical Literature, China National Knowledge Infrastructure, EMBASE, MEDLINE, and PsycINFO. We selected clinical studies that utilized fluoxetine for GAD in which all participants were Chinese.ResultsFifteen open-label, non-placebo trials were identified and analyzed; eleven anxiolytics were compared with fluoxetine separately. Short-term efficacy of fluoxetine had been established in these open-label, head-to-head controlled trials. Fluoxetine had rapid onset of action (approximately 1–2 weeks) and seemed to be effective in maintenance treatment. Fluoxetine was generally well-tolerated with the most common side effect of dry month and nausea. Compared to other anxiolytic agents, fluoxetine was equivalent with all of the comparative anxiolytics in terms of efficacy except mirtazapine which showed conflicting results with fluoxetine in two studies. In terms of side effects, fluoxetine was better tolerated than diazepam, doxepine, and amitriptyline, less tolerated than escitalopram, and had similar tolerability with duloxetine as well as alprazolam.ConclusionGiven the high risk of bias of the included studies, the overall small sample size of the studies, the lack of placebo control groups as well as the lack of certain clinically meaningful outcomes, it is not possible to recommend fluoxetine as a reliable first-line treatment in Chinese patients with GAD. Furthermore, no definitive implications for clinical practice in choosing anxiolytics can be drawn from this review. Trials with larger sample sizes, better quality, longer duration, and more clinically meaningful outcomes are needed in future research.

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Section: Comparative Safety Tolerability and Efficacy Of Fluoxetinesupporting

confidence: 89%

Clinical efficacy and safety of fluoxetine in generalized anxiety disorder in Chinese patients

Zou¹,

Ding²,

Flaherty³

et al. 2013

NDT

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“…Similar evidence exists for paroxetine [546,547,553-558] supporting its use as a first-line option. Paroxetine CR has a similar active ingredient, and although there are less data supporting its use, it is likely interchangeable with paroxetine as a first-line agent (Level 3) [564,565].…”

Section: Generalized Anxiety Disordermentioning

confidence: 62%

“…Paroxetine CR has a similar active ingredient, and although there are less data supporting its use, it is likely interchangeable with paroxetine as a first-line agent (Level 3) [564,565]. In head-to-head comparisons, the efficacy of SSRIs and SNRIs appear to be similar [546,547,549,556,558,570,571]. Some data suggest that escitalopram may be less effective than venlafaxine XR [548] or quetiapine XR [551].…”

Section: Generalized Anxiety Disordermentioning

confidence: 99%

Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

et al. 2014

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BackgroundAnxiety and related disorders are among the most common mental disorders, with lifetime prevalence reportedly as high as 31%. Unfortunately, anxiety disorders are under-diagnosed and under-treated.MethodsThese guidelines were developed by Canadian experts in anxiety and related disorders through a consensus process. Data on the epidemiology, diagnosis, and treatment (psychological and pharmacological) were obtained through MEDLINE, PsycINFO, and manual searches (1980–2012). Treatment strategies were rated on strength of evidence, and a clinical recommendation for each intervention was made, based on global impression of efficacy, effectiveness, and side effects, using a modified version of the periodic health examination guidelines.ResultsThese guidelines are presented in 10 sections, including an introduction, principles of diagnosis and management, six sections (Sections 3 through 8) on the specific anxiety-related disorders (panic disorder, agoraphobia, specific phobia, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder), and two additional sections on special populations (children/adolescents, pregnant/lactating women, and the elderly) and clinical issues in patients with comorbid conditions.ConclusionsAnxiety and related disorders are very common in clinical practice, and frequently comorbid with other psychiatric and medical conditions. Optimal management requires a good understanding of the efficacy and side effect profiles of pharmacological and psychological treatments.

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“…Both SSRIs and NE or NE/dopaminespecific drugs have been used in the treatment of GAD (Goodman, 2004), thus, it is possible to speculate that dual 5-HT/NE reuptake inhibitors may have greater efficacy than single reuptake inhibitors. Although recent studies comparing venlafaxine (75 mg and 150 mg/day) to paroxetine (40 mg/day) in GAD (Kim et al, 2006) and in panic disorder (Pollack et al, 2007) showed no significant differences between the two treatment groups, another study showed some differences in the treatment of panic disorder with venlafaxine 225 mg/day versus paroxetine 40 mg/day. As the NE reuptake effects of venlafaxine are evident at higher doses , these data provide some evidence of a differential effect of dual reuptake inhibitors versus SSRIs on anxiety disorders.…”

Section: Efficacy Of Dual Reuptake Inhibitors Efficacy In Depressionmentioning

confidence: 96%

Clinical evidence for serotonin and norepinephrine reuptake inhibition of duloxetine

Trivedi¹,

Desaiah²,

Ossanna³

et al. 2008

International Clinical Psychopharmacology

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Most antidepressants in clinical use are believed to function by enhancing neurotransmission of serotonin [5-hydroxytryptamine (5-HT)] and/or norepinephrine (NE) via inhibition of neurotransmitter reuptake. Agents that affect reuptake of both 5-HT and NE (serotonin-norepinephrine reuptake inhibitors) have been postulated to offer greater efficacy for the treatment of major depressive disorder (MDD). These dual-acting agents also display a broader spectrum of action, including efficacy for MDD and associated painful physical symptoms, diabetic peripheral neuropathic pain, generalized anxiety disorder, and fibromyalgia syndrome. Substantial preclinical evidence shows that duloxetine, an approved drug for the treatment of MDD, generalized anxiety disorder, and the management of diabetic peripheral neuropathic pain, inhibits reuptake of both 5-HT and NE. This paper reviews clinical and neurochemical evidence of duloxetine's effects on 5-HT and NE reuptake inhibition. The clinical evidence supporting duloxetine's effects on NE reuptake inhibition includes indirect measures such as altered excretion of NE metabolites, cardiovascular effects, and treatment-emergent adverse event profiles similar to those for other drugs believed to act through the inhibition of NE reuptake. In summary, the data presented in this report provide clinical evidence of a mechanism for duloxetine involving both 5-HT and NE reuptake inhibition in humans and are consistent with preclinical evidence for 5-HT/NE reuptake inhibition.

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Comparison of venlafaxine extended release versus paroxetine for treatment of patients with generalized anxiety disorder

Cited by 30 publications

References 11 publications

Clinical efficacy and safety of fluoxetine in generalized anxiety disorder in Chinese patients

Clinical efficacy and safety of fluoxetine in generalized anxiety disorder in Chinese patients

Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

Clinical evidence for serotonin and norepinephrine reuptake inhibition of duloxetine

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