A Randomized, Double-Blind, Active-Control Study of Sertraline Versus Venlafaxine XR in Major Depressive Disorder

Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tenn., USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 12/2006; 67(11):1674-81. DOI: 10.4088/JCP.v67n1102
Source: PubMed


Sertraline may produce dual neurotransmitter effects similar to the serotonin-norepinephrine reuptake inhibitors (SNRIs); however, it has been tested against an SNRI in only 1 previous study, and never at an optimal dose. The objective of the current multisite study was to compare relatively higher doses of sertraline (i.e., 150 mg/day) and venlafaxine extended release (XR) (225 mg/day) in outpatients with major depressive disorder.
Subjects with DSM-IV major depressive disorder were randomly assigned to 8 weeks of double-blind treatment with sertraline (N = 82) or venlafaxine XR (N = 78). The study ran from January 2002 through January 2003. The primary outcome measure was the Quality of Life Enjoyment and Satisfaction Questionnaire; secondary outcome variables included the 17-item Hamilton Rating Scale for Depression.
Both treatments led to significant improvement in depressive symptoms and quality-of-life measures. No significant differences were noted between treatment groups for final scores on the primary or secondary measures. The treatment groups did not differ significantly in the percentage of responders (sertraline = 55%, venlafaxine XR = 65%; intent-to-treat [ITT] sample) or remitters (sertra-line = 38%, venlafaxine XR = 49%; ITT sample), although the proportions are similar to those found in earlier selective serotonin reuptake inhibitor (SSRI) vs. venlafaxine meta-analyses. In patients who achieved the maximum dose of drug and maintained it for 3 weeks, response rates were similar to those found at lower doses (sertraline = 59%, venlafaxine XR = 70%); however, remission rates for this sample were comparable for both drug groups (sertraline = 48%, venlafaxine XR = 50%).
The efficacies of sertraline and venlafaxine XR were comparable. Although response and remission rates did not differ statistically, the rates were analogous to those reported in previous meta-analyses. However, at clinically relevant higher doses, the remission rates were very similar. identifier NCT00179283.

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    • "Nevertheless, this latter finding could be interesting because antidepressants with noradrenergic activity (such as tricyclics ) have been traditionally associated with a better response in males. This result could be due to dosedependent effects of venlafaxine; in fact, it shows noradrenergic effects (which maybe responsible for better response in males) only at doses of 150 mg/d or higher (Shelton et al. 2006). In the reports we analysed the mean daily dose of venlafaxine was 160 mg, and it is possible that serotoninergic effects predominate at this dose, related to a better response in females. "
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    ABSTRACT: Despite the well-known efficacy of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) in the treatment of major depressive disorder, there is a lack of indications for each drug in different groups of patients. The aim of this study is to investigate the possible role of clinical sociodemographic factors as moderators of clinical response to venlafaxine (SNRI) and sertraline (SSRI). Research was performed on Medline and EMBASE for randomized control trials in English focused on sertraline and venlafaxine in the treatment of major depressive disorder and 59 studies were included. Clinical efficacy of each treatment was assessed on the basis of Hamilton Depressive Rating Scale and Montgomery-Asberg Depression Rating Scale. A metaregression analysis was performed to evaluate the role of clinical and sociodemographic factors as moderators of outcome, calculating the effect of each variable with the random-effects method. Gender, ethnicity and duration of depressive episode could have a role in prediction of clinical response to both antidepressants. Venlafaxine seems to have better effects in females and in Caucasian patients. Sertraline seems to be more efficacious in the treatment of females. Both drugs were more efficacious in patients who suffered a shorter episode of illness. Our results could represent an interesting point of view in the perspective of choosing the most suitable therapy based on clinical and social features for each patient. Metaregression is a retrospective analysis, based on the cumulative results of previous studies, so the lack of original data could represent the main limitation in this report and in the interpretation of the results obtained.
    The International Journal of Neuropsychopharmacology 08/2013; 17(01):1-8. DOI:10.1017/S1461145713000746 · 4.01 Impact Factor
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    • "With our expanded search, we obtained 17 additional articles on AETs (Fabre et al. 1995 ; DeMartinis et al. 1996 ; Stahl, 2000 ; Dinan, 2001 ; Detke et al. 2002 ; Golden et al. 2002 ; Goldstein et al. 2002, 2004 ; Bielski et al. 2004 ; Trivedi et al. 2004 ; Derubeis et al. 2005 ; Fava et al. 2005 ; Sir et al. 2005 ; Benkert et al. 2006 ; Langworth et al. 2006 ; Mulder et al. 2006 ; Shelton et al. 2006). No additional exclusion criteria for AETs were identified. "
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    ABSTRACT: Generalizability of antidepressant efficacy trials (AETs) to daily practice is questioned because of their very stringent patient selection. This study aims to determine eligibility for AETs of out-patients suffering from major depression in a routine out-patient setting and investigates influence of eligibility on treatment outcome. Data collection (n = 1653) was performed through routine outcome monitoring by independent trained research nurses. The Mini-International Neuropsychiatric Interview Plus and the Dimensional Assessment of Personality Pathology, short Dutch version were used for diagnostic assessment and personality pathology screening. The Montgomery-Asberg Depression Rating Scale (MADRS) was used for assessment of baseline severity and treatment outcome. Eligibility was assessed by stepwise application of commonly used exclusion criteria. Influence of eligibility on treatment outcome was investigated in a subsample of the 1653 patients who had at least one follow-up assessment (n = 626). Eligible and non-eligible patients were compared on proportion of response (50% reduction) and remission on MADRS (MADRS ≤ 10). Altogether, 17-25% of the patients were eligible for AETs. The most common reasons for exclusion would be 'not meeting minimum baseline severity' and 'presence of co-morbid Axis I disorder'. Eligible and non-eligible patients did not differ in treatment outcome. Only 'meeting the minimum baseline severity' is associated with remission. The majority of 'real life' out-patients are not eligible for AETs. However, the influence of eligibility on treatment outcome seems to be small. This suggests that stringent patient selection by eligibility criteria is not the major reason for lack of generalizability of AETs. Exclusion of less severely depressed patients from the analyses resulted in better treatment outcome. Milder depression is highly prevalent in daily practice and more research into treatment effectiveness in milder depression is warranted.
    Psychological Medicine 11/2010; 41(7):1353-63. DOI:10.1017/S0033291710002175 · 5.94 Impact Factor
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    Biological Psychiatry 01/2008; 62(11):1217-27. DOI:10.1016/j.biopsych.2007.03.027 · 10.26 Impact Factor
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