Venlafaxine Extended Release in Posttraumatic Stress Disorder

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
Journal of Clinical Psychopharmacology (Impact Factor: 3.24). 07/2006; 26(3):259-67. DOI: 10.1097/
Source: PubMed

ABSTRACT This 12-week, double-blind, multicenter trial evaluated the efficacy of venlafaxine extended release (ER), sertraline, and placebo in adult outpatients (N = 538) with a primary diagnosis of posttraumatic stress disorder (PTSD), as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, symptoms for 6 months or more and 17-item Clinician-administered PTSD Scale (CAPS-SX17) score of 60 or more. Patients were randomly assigned to receive placebo or flexible doses of venlafaxine ER (37.5-300 mg/d) or sertraline (25-200 mg/d) for 12 weeks or less. The primary outcome was the baseline-to-end point change in total CAPS-SX17 score (last observation carried forward). Secondary measures included CAPS-SX17 symptom cluster scores for reexperiencing/intrusion, avoidance/numbing, and hyperarousal; frequency of remission (CAPS-SX17 < or =20); and changes in Davidson Trauma Scale total score and symptom cluster scores for avoidance/numbing, hyperarousal, and reexperiencing/intrusion. Mean changes in CAPS-SX17 scores were -41.8, -39.4, and -33.9 for venlafaxine ER (P < 0.05 vs. placebo), sertraline, and placebo, respectively. Mean changes for venlafaxine ER, sertraline, and placebo in CAPS-SX17 cluster scores were -13.0, -11.7, and -11.0 for reexperiencing; -17.1, -16.8, and -13.7 (P < 0.05 both active treatments vs. placebo) for avoidance/numbing; and -11.8, -10.9, and -9.2 (P < 0.05 venlafaxine vs. placebo) for hyperarousal. Week 12 remission rates were venlafaxine ER 30.2% (P < 0.05 vs. placebo), sertraline 24.3%, and placebo 19.6%. The venlafaxine ER group had significantly better Davidson Trauma Scale total and cluster scores than placebo. Mean maximum daily doses were 225-mg venlafaxine ER and 151-mg sertraline. Both treatments were generally well tolerated. Study results suggest that venlafaxine ER is effective and well tolerated in the short-term treatment of PTSD.

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Available from: Jonathan Davidson, Sep 15, 2014
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    • "There is some evidence that tricyclics are more effective in men and SSRI in women whom have depression (Kornstein et al., 2000). 5. Further studies are needed to investigate the dose effects, safety and to establish whether tricyclic drugs are superior to SSRI. The only study that compared a SSRI against a SNRI in PTSD shows that the SNRI, but not the SSRI, is superior to placebo; and remission rates show a pattern in which the SSRI was intermediate and not differing from either comparator (Davidson et al., 2006). "
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    ABSTRACT: Serotonin (SSRI) and serotonin-norepinephrine (SNRI) reuptake inhibitors (SSRI) are the first-line recommended drug treatments for post-traumatic stress disorder (PTSD); but despite their benefits, much residual pathology remains and no new drugs have yet emerged with a clearly demonstrated benefit for treating the disorder. A case is made that tricyclic drugs deserve a closer look, based on their ability to affect several of the main neurotransmitters that are relevant to PTSD. Their promising efficacy, which was shown 30 years ago, had not been followed up, until a recent trial of desipramine found advantages over a SSRI in PTSD with comorbid alcohol dependence. Opportunities exist for studying newer and purportedly safer tricyclic formulations, as well as further the work with older, established compounds. A reappraisal of their risk:benefit ratio seems in order, when treating PTSD. © The Author(s) 2015.
    Journal of Psychopharmacology 01/2015; 29(3). DOI:10.1177/0269881114565143 · 3.59 Impact Factor
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    • "Good efficacy of venlafaxine ER was found in two RCTs.72,73 Some promising results were noted in an uncontrolled naturalistic study investigating duloxetine in the treatment of male patients with therapy-refractory PTSD.74 "
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    ABSTRACT: Post-traumatic stress disorder (PTSD) may be associated with long-lasting psychological suffering, distressing psychosocial disability, markedly reduced health-related quality of life, and increased morbidity and mortality in a subgroup of individuals in the aftermath of serious traumatic events. Both etiopathogenesis and treatment modalities of PTSD are best conceptualized within a biopsychosotial model. Pharmacotherapy may lay claim to a major role in the multimodal treatment approaches. Here we outline two different pharmacotherapeutic trends that aim to modify the encoding, consolidation, and rehearsal of traumatic memory in order to reduce the risk of PTSD immediately after trauma exposure on the one hand, and that endeavor to treat the clinical state of PTSD on the other. The theoretical rationales of both pharmacological strategies are the complex neurobiological underpinnings that characterize traumatic memory organization and clinical PTSD. Meanwhile, promising data from randomized controlled trials have been obtained for both approaches. Empirical evidence may inform clinicians in their clinical efforts for this special group of patients. The efficacy of several classes of drugs that have been investigated within a context of research should be evaluated critically and still have to stand the test of effectiveness in daily clinical practice. From a patient perspective, empirical results may serve as a psychoeducative guideline to what pharmacotherapeutic approaches may realistically achieve, what their risks and benefits are, and what their limits are in contributing to reducing the often major chronic suffering caused by serious traumatic events. Ethical issues have to be considered, particularly in the context of pharmacological strategies projected to prevent PTSD in the aftermath of traumatic exposure.
    Dialogues in clinical neuroscience 06/2014; 16(2):227-37.
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    • "There is mixed evidence from randomized controlled trials for the efficacy of fluoxetine, another SSRI (Hertzberg, Feldman, Beckham, Kudler, & Davidson, 2000; Martenyi, Brown, & Caldwell, 2007; Martenyi & Soldatenkova, 2006). There is also some support from randomized controlled trials for venlafaxine, a serotonin-norepinephrine reuptake inhibitor (Davidson et al., 2006); imipramine , a tricyclic antidepressant (Kosten, Frank, Dan, McDougle, & Giller, 1991); phenelzine, a monoamine oxidase inhibitor (Kosten et al., 1991); and lamotrigine, an anticonvulsant (Hertzberg et al., 1999), in treating different aspects of the disorder. There is also some evidence of efficacy for mirtazapine, a tetracyclic antidepressant, from a pilot randomized controlled trial (Davidson et al., 2003) and for the antipsychotics risperidone (Padala et al., 2006) and olanzapine (Stein, Kline, & Matloff, 2002) in various populations from controlled trials. "
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