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Efficacy and tolerability of venlafaxine versus specific serotonin reuptake inhibitors in treatment of major depressive disorder: a meta-analysis of published studies

de Silva, Varuni Asanka; Hanwella, Raveen

International Clinical Psychopharmacology: January 2012 - Volume 27 - Issue 1 - p 8–16
doi: 10.1097/YIC.0b013e32834ce13f
Review

Specific serotonin reuptake inhibitors (SSRIs) are considered as first-line treatment in major depressive disorder (MDD). There is evidence that venlafaxine may be more effective than several antidepressants in the treatment of MDD. This meta-analysis includes all published, randomized, double-blind, head-to-head trials, which compared venlafaxine and an SSRI in the treatment of MDD in adults. Twenty-six trials comparing venlafaxine with an SSRI were included (total participants: 5858). Meta-analysis using a random effect model showed that venlafaxine was superior to SSRIs in achieving remission [odds ratio (OR)=1.13, 95% confidence interval (CI)=1.0–1.28, P=0.05] and response (OR=1.17, 95% CI=1.03–1.34, P=0.02). Subgroup analysis found that venlafaxine had a significantly better response rate than fluoxetine (OR=1.28, 95% CI=1.05–1.55, P=0.01). There were no significant differences in response or remission between venlafaxine and other individual SSRIs. There was no significant difference in all cause discontinuation between venlafaxine and SSRIs (OR=1.10, 95% CI=0.97–1.25, P=0.15). Venlafaxine had significantly higher discontinuation due to adverse events compared with SSRIs (OR=1.41, 95% CI=1.10–1.79, P=0.006). The superior efficacy of venlafaxine over SSRIs is of clinical importance. However, higher rates of discontinuation due to adverse events for venlafaxine compared with SSRIs are a disadvantage. Findings of this meta-analysis that included only published studies were similar to those from meta-analysis that included unpublished data.

Department of Psychological Medicine, Faculty of Medicine, Colombo, Sri Lanka

Correspondence to Varuni Asanka de Silva, MBBS, MD(Psych), Senior Lecturer in Psychiatry, Department of Psychological Medicine, Faculty of Medicine, Colombo, Sri Lanka Tel: 94112574011; fax: 94112691581; e-mail: varunidesilva2@yahoo.co.uk

Received June 6, 2011

Accepted September 7, 2011

© 2012 Lippincott Williams & Wilkins, Inc.