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Relatively Greater Efficacy Achieved With Venlafaxine Compared to Selective Serotonin Reuptake Inhibitors in Anxious Depression

By Paula Moyer

ATLANTA, GA -- June 2, 2005 -- Patients who have mixed depression and anxiety appear to get a relatively better effect when they are treated with venlafaxine (Effexor) than they do with either a selective serotonin reuptake inhibitor (SSRI) or placebo.

Jeff Musgnung, MT, Director of Neuroscience Research, Global Medical Affairs, Wyeth Pharmaceuticals, presented the findings here May 25^th at the American Psychiatric Association (APA) Annual Meeting.

Wyeth Pharmaceuticals manufactures the serotonin norepinephrine reuptake inhibitor (SNRI) Effexor and funded the study.

"These findings come from the largest known pooled analysis of treatments for anxiety and depression," Musgnung said. "Although SSRIs and venlafaxine were both effective in treating concurrent anxiety and depression, venlafaxine produced a higher rate of remission."

The analysis involved 7422 patients who had participated in 31 randomized, double-blind trials that compared venlafaxine immediate-release and venlafaxine sustained-release to selected SSRIs and placebo.

Within the cohort studied, 3273 were treated with one of the two formulations of venlafaxine; 3217 were treated with one of the following SSRIs: fluoxetine, paroxetine, sertraline, citalopram, or fluvoxamine. Nine studies evaluated 932 patients in a placebo arm.

The researchers defined remission as a score of 7 or less on the Hamilton Depression Rating Scale version 17 (HAM-D17). They also used more stringent alternate criteria that defined remission as a HAM-D17 score of 5 or less. They analyzed data through week 8 of all of the studies.

Within the overall population, 5370 patients (72%) had concurrent anxiety and depression. Among these patients, 2399 were treated with venlafaxine, 2317 were treated with an SSRI, and 654 were given a placebo.

The remission rates by week 8 by treatment type were as follows: venlafaxine 39% (P < .001 versus SSRIs and versus placebo; SSRI 33%; placebo 24% (P < .001 for SSRIs versus placebo).

Dr. Musgnung noted that when a HAM-D17 score of 5 or less was used, remission rates at week 8 were as follows: 27% for venlafaxine, 22% for SSRIs, and 15% for placebo (P < .001 for venlafaxine versus SSRIs and versus placebo, P < .001 for SSRIs versus placebo).

Assessment of patients using the Clinical Global Impression of Improvement (CGI-I) yielded similar comparisons and probability values at week 8.

The investigators concluded that, for patients with anxious depression, both venlafaxine and the investigated SSRIs were associated with a higher remission rate at week 8 than was placebo.

They also concluded that there was a significantly higher rate of remission at week 8 with both formulations of venlafaxine compared with SSRIs in the same subtype of depression.

"These results suggest a relatively greater efficacy of venlafaxine compared to the SSRIs in the treatment of anxious depression," they added

The study was supported by Wyeth Research, which manufactures Effexor.


[Presentation title: Venlafaxine Versus SSRIs and Placebo in the Treatment of Anxious Depression. Abstract NR625]

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