Comparing venlafaxine extended release and fluoxetine for preventing the recurrence of major depression: results from the PREVENT study.
ABSTRACT This secondary analysis from the Prevention of Recurrent Episodes of Depression with Venlafaxine Extended Release (ER) for Two Years (PREVENT) study compared the efficacy of venlafaxine ER and fluoxetine for the prevention of recurrence in patients with a history of recurrent major depressive disorder (MDD). Patients received double-blind treatment with venlafaxine ER (75-300 mg/d) or fluoxetine (20-60 mg/d) for 10 weeks (acute phase). Responders (17-item Hamilton Rating Scale for Depression [HAM-D(17)] score ≤ 12 and ≥ 50% reduction from baseline) continued on the same treatment during the 6-month continuation phase. At the start of the first and second 12-month maintenance phases, venlafaxine ER responders were randomly assigned to receive venlafaxine ER or placebo, whereas patients receiving fluoxetine continued to receive fluoxetine throughout both maintenance phases. The primary outcome was time to recurrence (HAM-D(17) > 12, reduction in HAM-D(17) score ≤ 50% from acute baseline, and meeting DSM-IV criteria for a diagnosis of MDD), which was assessed using Kaplan-Meier estimates. Using the primary definition of recurrence, the estimated probability of not experiencing a recurrence was 71.9% for venlafaxine ER (n = 160) and 55.8% for fluoxetine (n = 99) across 24 months of maintenance treatment. For this primary analysis, the overall effect of venlafaxine ER treatment was not statistically significant (p = 0.399) compared with fluoxetine; however, a significant treatment-by-time interaction was observed (p = 0.034). No significant between-group differences were observed with any of the secondary efficacy variables. Venlafaxine ER and fluoxetine were similarly well tolerated across 2 years of maintenance-phase therapy.
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ABSTRACT: We evaluated the efficacy and side effects of the selective serotonin and norepinephrine reuptake inhibitor antidepressant duloxetine in older adults with dysthymic disorder.SAGE open medicine. 05/2014; 2.
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ABSTRACT: Objective: To provide general practitioners with a comparison of major depressive disorder treatments received in primary care and psychiatric clinic settings, a focus on treatment outcomes related to currently prescribed antidepressants, and a review of new and emerging therapeutic strategies. Data Sources: English-language evidence-based guidelines and peer-reviewed literature published between January 1, 2005, and December 31, 2011, were identified using PubMed, MEDLINE, and EMBASE. All searches contained the terms major depressive disorder and unipolar depression, and excluded the terms bipolar disorder/manic depressive disorder. The following search terms were also included: naturalistic study, antidepressant, relapse, recurrence, residual symptoms, response, remission, sequential medication trials, and treatment-resistant depression. Study Selection: Meta-analyses, systematic reviews, and practice guidelines were included. Bibliographies were used to identify additional articles of interest. Data Extraction: Abstracts and articles were screened for relevance to primary care practice. Population-based studies and those involving patients treated in primary care were used whenever possible. Data Synthesis: Achieving remission from a major depressive episode is important to improve functional outcomes and to reduce relapse and recurrence. Despite the availability of numerous antidepressants, as many as 50% of patients require treatment modifications beyond first-line therapy. Among remitters, 90% report residual symptoms that may interfere with function. Patients treated in primary care often have chronic depression (symptom duration ≥ 24 months at presentation) and medical comorbidities. These are clinical predictors of worse outcomes and require individualized attention when treatment is initiated. Antidepressants differ in efficacy, tolerability, and side effects-factors that may affect adherence to treatment. Conclusions: Major depressive disorder is highly prevalent in primary care and is among the most common causes of loss of disability-adjusted life-years worldwide. There are few differences in clinical profiles between depressed patients in primary care and those in specialist clinics, although differences in symptoms and comorbid conditions among individual depressed patients present a challenge for the physician providing individualized treatment. The goal of treatment is remission with good functional and psychosocial outcomes. Physicians in primary care should have expertise in working with a number of current antidepressant approaches and an awareness of new and emerging treatments.The primary care companion to CNS disorders. 01/2013; 15(2).
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ABSTRACT: Abstract It is of high clinical interest to better understand the timecourse through which psychiatric drugs produce their beneficial effects. While a rough estimate of the time lag between initiating monoaminergic antidepressant therapy and the onset of therapeutic effect in depressed subjects is two weeks, much less is known about when these drugs reach maximum effect. This paper briefly examines studies that directly address this question through long-term antidepressant administration to humans, while also putting forth a simple theoretical approach for estimating the time required for monoaminergic antidepressants to reach maximum therapeutic effect in humans. The theory invokes a comparison between speed of antidepressant drug response in humans and in rodents, focusing on the apparently greater speed in rodents. The principal argument is one of proportions, comparing earliest effects of these drugs in rodents and humans, versus their time to reach maximum effect in these organisms. If the proportionality hypothesis is even coarsely accurate, then applying these values or to some degree their ranges to the hypothesis, may suggest that monoaminergic antidepressants require a number of years to reach maximum effect in humans, at least in some individuals.The International journal of neuroscience 10/2013; · 1.53 Impact Factor