There are numerous antidepressant medications currently on the market, but sadly, many patients still experience the debilitating symptoms of depression even with treatment. A new study published in the February 15th issue of Biological Psychiatry set out to compare two popular classes of antidepressants, the newer serotonin and norepinephrine reuptake inhibitors (SNRIs), like venlafaxine (Effexor), and the older selective serotonin reuptake inhibitors (SSRIs), like fluoxetine (Prozac) and citalopram (Celexa), to determine if one provides an overall greater benefit.

To do so, the authors performed a meta-analysis, by pooling the results of 34 double-blind randomized controlled trials that compared a single SNRI, venlafaxine, to other SSRIs. Dr. Charles Nemeroff, senior author on the paper, reports their findings: “Venlafaxine was superior to SSRIs in efficacy overall, and moreover, statistically superior to fluoxetine but not to paroxetine, sertraline or citalopram. Venlafaxine had a higher dropout rate due to adverse events.” These findings indicated a 5.9% advantage in remission rates for venlafaxine. The authors also report that the typical doctor would need to treat 17 patients to have a single patient benefit from being treated with venlafaxine rather than an SSRI.

Acknowledging the seemingly small advantage, John H. Krystal, M.D., Editor of Biological Psychiatry and affiliated with both Yale University School of Medicine and the VA Connecticut Healthcare System, comments that this article “highlights an advance that may have more importance for public health than for individual doctors and patients.” He explains this reasoning:

If the average doctor was actively treating 200 symptomatic depressed patients and switched all of them to venlafaxine from SSRI, only 12 patients would be predicted to benefit from the switch. This signal of benefit might be very hard for that doctor to detect. But imagine that the entire population of depressed patients in the United States, estimated to be 7.1% of the population or over 21 million people, received a treatment that was 5.9% more effective, then it is conceivable that more than 1 million people would respond to venlafaxine who would not have responded to an SSRI. This may be an example of where optimal use of existing medications may improve public health even when it might not make much difference for individual doctors and patients.

Thus, in the typical clinical practice this difference constitutes a barely detectable benefit, but this difference could be meaningful across the large population of depressed patients in the United States.

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Notes to Editors:

The article is “Comprehensive Analysis of Remission (COMPARE) with Venlafaxine versus SSRIs” by Charles B. Nemeroff, Richard Entsuah, Isma Benattia, Mark Demitrack, Diane M. Sloan and Michael E. Thase. Dr. Nemeroff is affiliated with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia. Drs. Entsuah, Benattia, and Demitrack are with Wyeth Research in Collegeville, Pennsylvania. Dr. Sloan is with Advogent in Wayne, New Jersey. Dr. Thase is from the Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. The article appears in Biological Psychiatry, Volume 63, Issue 4 (February 15, 2008), published by Elsevier.

Full text of the article mentioned above is available upon request. Contact Jayne M. Dawkins at (215) 239-3674 or .(JavaScript must be enabled to view this email address) to obtain a copy or to schedule an interview.

About Biological Psychiatry

This international rapid-publication journal is the official journal of the Society of Biological Psychiatry. It covers a broad range of topics in psychiatric neuroscience and therapeutics. Both basic and clinical contributions are encouraged from all disciplines and research areas relevant to the pathophysiology and treatment of major neuropsychiatric disorders. Full-length and Brief Reports of novel results, Commentaries, Case Studies of unusual significance, and Correspondence and Comments judged to be of high impact to the field are published, particularly those addressing genetic and environmental risk factors, neural circuitry and neurochemistry, and important new therapeutic approaches. Concise Reviews and Editorials that focus on topics of current research and interest are also published rapidly.

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