Citation

Thase ME, Ninan PT, Musgnung JJ, Trivedi MH. Prim. Care Companion J. Clin. Psychiatry 2011; 13(1): e1-e9.

Copyright

(Copyright © 2011, Physicians Postgraduate Press)

DOI

10.4088/PCC.10m00979blu

PMID

unavailable

Abstract

BACKGROUND: This randomized, open-label, rater-blinded, multicenter study compared treatment outcomes with the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine extended release (ER) with selective serotonin reuptake inhibitors (SSRIs) in primary care patients with major depressive disorder.

METHOD: Study data were collected from November 29, 2000, to March 4, 2003. Outpatients who met diagnostic criteria for major depressive disorder according to the Mental Health Screener, a computer-administered telephone interview program that screens for the most common mental disorders, and had a total score on the 17-item Hamilton Depression Rating Scale (HDRS17) ≥ 20 were randomly assigned to receive up to 6 months of open-label venlafaxine ER 75-225 mg/d (n = 688) or an SSRI (n = 697): fluoxetine 20-80 mg/d, paroxetine 20-50 mg/d, citalopram 20-40 mg/d, and sertraline 50-200 mg/d. The primary outcome was remission (HDRS17 score ≤ 7) at study end point using the last-observation-carried-forward method to account for early termination. A mixed-effects model for repeated measures (MMRM) analysis evaluated secondary outcome measures.

RESULTS: Fifty-one percent of patients completed the study. Month 6 remission rates did not differ significantly for venlafaxine ER and the SSRIs (35.5% vs 32.0%, respectively; P =.195). The MMRM analysis of HDRS17 scores also did not differ significantly (P =.0538). Significant treatment effects favoring the venlafaxine ER group were observed for remission rates at days 30, 60, 90, and 135 and a survival analysis of time to remission (P =.006), as well as Clinical Global Impressions-severity of illness scale (P =.0002); Hospital Anxiety and Depression Scale-Anxiety subscale (P =.03); 6-item Hamilton Depression Rating Scale, Bech version (P =.009); and Quick Inventory of Depressive Symptomatology-Self-Report (P =.0003).

CONCLUSIONS: Remission rates for patients treated with venlafaxine ER or an SSRI did not differ significantly after 6 months of treatment.

RESULTS of most secondary analyses suggested that SNRI treatment had a greater antidepressant effect versus the SSRIs studied. © 2011 Physicians Postgraduate Press, Inc.

Language: en

Keywords

adult; human; female; male; insomnia; randomized controlled trial; suicide attempt; interview; major depression; disease severity; drug overdose; fatigue; article; major clinical study; primary medical care; controlled study; citalopram; fluoxetine; paroxetine; serotonin uptake inhibitor; sertraline; venlafaxine; xerostomia; somnolence; practice guideline; constipation; drug efficacy; diarrhea; nausea; drug withdrawal; Hamilton scale; multicenter study; sweating; hypertension; side effect; low drug dose; remission; drug formulation; dizziness; treatment response; drug induced headache; drug dose increase; treatment duration; open study; upper respiratory tract infection; sinusitis