Richard C. Shelton, MD; Kirsten L. Haman, PhD; Mark H. Rapaport, MD; Ari Kiev, MD; Ward T. Smith, MD; Robert M. A. Hirschfeld, MD; R. Bruce Lydiard, MD, PhD; John M. Zajecka, MD; and David L. Dunner, MD
Objective: Sertraline may produce dual
neurotransmitter effects similar to the
serotonin-norepinephrine reuptake inhibitors (SNRIs); however, it has
been tested against an SNRI in only 1 previous study,
and never at an optimal dose. The objective of the
current multisite study was to compare relatively higher
doses of sertraline (i.e., 150 mg/day) and venlafaxine
extended release (XR) (225 mg/day) in outpatients
with major depressive disorder.
Method: Subjects with DSM-IV major
depressive disorder were randomly assigned to 8 weeks of
double-blind treatment with sertraline (N = 82) or
venlafaxine XR (N = 78). The study ran from January 2002
through January 2003. The primary outcome measure was
the Quality of Life Enjoyment and Satisfaction
Questionnaire; secondary outcome variables included the
17-item Hamilton Rating Scale for Depression.
Results: Both treatments led to significant
improvement in depressive symptoms and
quality-of-life measures. No significant differences were noted
between treatment groups for final scores on the
primary or secondary measures. The treatment groups did
not differ significantly in the percentage of
responders (sertraline = 55%, venlafaxine XR = 65%; intent-to-treat [ITT] sample) or remitters (sertraline
= 38%, venlafaxine XR = 49%; ITT sample), although the proportions are similar to those found in
earlier selective serotonin reuptake inhibitor (SSRI) vs.
venlafaxine meta-analyses. In patients who achieved
the maximum dose of drug and maintained it for 3
weeks, response rates were similar to those found at
lower doses (sertraline = 59%, venlafaxine XR = 70%);
however, remission rates for this sample were
comparable for both drug groups (sertraline = 48%, venlafaxine
XR = 50%).
Conclusions: The efficacies of sertraline and
venlafaxine XR were comparable. Although response
and remission rates did not differ statistically, the
rates were analogous to those reported in previous
meta-analyses. However, at clinically relevant higher
doses, the remission rates were very similar.
Clinical Trials
Registration: ClinicalTrials.gov identifier NCT00179283.
J Clin Psychiatry 2006;67(11):1674-1681
© Copyright 2006 Physicians Postgraduate Press, Inc.