Aytekin Sir, MD; Russell F. D'Souza, MD, MPM; Sukru Uguz, MD; Tom George, DPM, MRCPsych, FRANZCP; Simavi Vahip, MD; Malcolm Hopwood, MD, MPM, RANZCP; Andrew J. Martin, PhD; William Lam, MD, PhD; and Tal Burt, MD
Background: The comparative efficacy of
selective serotonin reuptake inhibitors (SSRIs) and
serotonin-norepinephrine reuptake inhibitors (SNRIs) was
recently debated. Meta-analyses, based mainly on
fluoxetine comparator data, suggest that the SNRI venlafaxine has superior efficacy to SSRIs in
treatment of major depression.
Objective: To compare quality of life (QOL),
efficacy, safety, and tolerability associated with
sertraline and venlafaxine extended release (XR) for treatment
of DSM-IV major depression.
Method: This was an 8-week, double-blind,
randomized study of sertraline (50-150 mg/day)
versus venlafaxine XR (75-225 mg/day), followed by a
2-week taper period. Subjects were recruited from 7
sites in Turkey and 6 sites in Australia between
October 2002 and July 2003. The primary outcome
measure was the Quality of Life Enjoyment and
Satisfaction Questionnaire. Secondary outcome measures
included measures of depression (including response and
remission), anxiety, pain, safety (e.g., blood pressure),
and tolerability (e.g., discontinuation symptoms).
Results: A total of 163 subjects received
study treatment (women, 69%; mean age, 37.0
[SD = 12.9] years). No significant differences in QOL or
efficacy were noted between treatments on the primary or
secondary endpoints for the total study population or
the anxious depression and severe depression subgroups.
A priori analyses of symptoms associated with
treatment discontinuation demonstrated no difference
between treatment groups. However, in post hoc analyses,
sertraline was associated with less burden of moderate
to severe discontinuation symptoms. Venlafaxine XR
was associated with a relative increase in mean blood
pressure (supine diastolic blood pressure, -4.4 mm Hg
difference at week 8/last observation carried forward).
Conclusion: Sertraline and venlafaxine XR
demonstrated comparable effects on QOL and efficacy
in treatment of major depression, although sertraline
may be associated with a lower symptom burden
during treatment discontinuation and a reduced risk of
blood pressure increase.
J Clin Psychiatry 2005;66(10):1312-1320
© Copyright 2005 Physicians Postgraduate Press, Inc.