Article

Venlafaxine Extended Release in Posttraumatic Stress Disorder

Duke University, Durham, North Carolina, United States
Journal of Clinical Psychopharmacology (Impact Factor: 3.24). 07/2006; 26(3):259-67. DOI: 10.1097/01.jcp.0000222514.71390.c1
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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    • "During the consultations, medication is initiated in accordance with the medical treatment algorithm of the clinic, which constitutes the pharmaceutical part of TAU. The algorithm is based on the present knowledge on treatment of traumatised refugees[5,50,51]. In accordance with this, sertraline is first choice medication, and venlafaxine second choice of medication. "
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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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    • "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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