Response and Remission Rates in Different Subpopulations With Major Depressive Disorder Administered Venlafaxine, Selective Serotonin Reuptake Inhibitors, or Placebo
J Clin Psychiatry 2001;62(11):869-877
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Background: Most examinations of the
clinical efficacy of drugs used to treat depression pool subjects
across gender and age groups. This investigation compared these
patient subpopulations on the basis of remission and response
rates associated with venlafaxine and selective serotonin
reuptake inhibitor (SSRI) treatment.
Method: A meta-analysis of original data from 8
comparable double-blind, active-controlled, randomized clinical
trials (4 also placebo-controlled) was conducted. Antidepressant
efficacy was assessed for patients (N = 2045) aged 18 to 83 years
(subgroups: <= 40, 41-54, 55-64, and >= 65 years) who met
DSM-III-R criteria for major depression or DSM-IV criteria for
major depressive disorder and were randomly assigned to receive
venlafaxine (immediate release, N = 474; extended release, N =
377), one of several SSRIs (N = 748), or placebo (N = 446) for up
to 8 weeks. Symptoms of depression were assessed using the
Hamilton Rating Scale for Depression (HAM-D). Remission was
defined as a HAM-D-17 score <= 7, response was defined
as >= 50% decrease in HAM-D-21 score, and absence
of depressed mood was defined as a HAM-D depressed mood
item score of 0.
Results: We detected no significant
age-by-treatment, gender-by-treatment, or
age-by-gender-by-treatment interactions; men and women of
different ages within a given antidepressant treatment group
exhibited similar rates of remission, response, and absence of
depressed mood. Regardless of age or gender, remission rates
during venlafaxine therapy were significantly higher than during
SSRI therapy (remission rates at week 8: venlafaxine, 40%-55% vs.
SSRI, 31%-37%; p < .05). Regardless of patient age or gender,
onset of remission was more rapid with venlafaxine than with SSRI
treatment. By contrast, rates of absence of depressed mood with
venlafaxine (34%-42%) and SSRIs (31%-37%) did not differ
significantly and tended to be similar for all patient subgroups.
Conclusion: These data suggest that men and
women have comparable responses to SSRIs and venlafaxine across
various age groups. Moreover, patients exhibited a more rapid
onset and a greater likelihood of remission with venlafaxine
therapy than with SSRI therapy regardless of age or gender.