Nemeroff et al. (
1
) present a comprehensive meta-analysis of venlafaxine versus selective serotonin
reuptake inhibitor (SSRI) in the treatment of major depression and address the important
question of whether there are differences in efficacy between newer antidepressants.
The authors show a small but significant advantage of venlafaxine over fluoxetine
in achieving remission. They report, compared with all SSRIs, a number needed to treat
(NNT) of 17, which would be of public health relevance. In a recent review (
2
) based on published studies with more rigorous and restrictive inclusion criteria,
we could not show a statistically significant advantage of venlafaxine versus SSRIs
in remission rates but found only a small advantage in response rates. Both reviews
have in common that if there are any differences in the efficacy of venlafaxine and
SSRIs these differences are small. Furthermore, both reviews indicate that venlafaxine
seems to be less well-tolerated.To read this article in full you will need to make a payment
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References
- Comprehensive analysis of remission (COMPARE) with venlafaxine versus SSRIs.Biol Psychiatry. 2008; 63: 424-434
- Re-evaluation of the efficacy and tolerability of venlafaxine vs SSRI: Meta-analysis.Psychopharmacology. 2007; 196: 511-520
- Comparing the effects of antidepressants: Consensus guidelines for evaluating quantitative reviews of antidepressant efficacy.Neuropsychopharmacology. 2006; 30: 445-460
- Increased remission rates with venlafaxine compared with fluoxetine in hospitalized patients with major depression and melancholia.Int Clin Psychopharmacol. 2000; 15: 29-34
- “Wish bias” in antidepressant drug trials?.J Clin Psychopharmacol. 2004; 24: 126-130
Article info
Publication history
Published online: June 12, 2009
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© 2009 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
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- ReplyBiological PsychiatryVol. 66Issue 5
- PreviewWe appreciate the thoughtful comments of Koesters et al. (1). We were of course aware of their meta-analysis, which focused on a subset of the published studies comparing venlafaxine and various selective serotonin reuptake inhibitors (SSRIs) and regret that their report was not published in time to be available for discussion in our article. With respect to the first point raised by Koesters et al., we agree that the differences between the results of their meta-analysis and ours are small. We also agree that publication bias can distort the results of meta-analyses; this is why we included all randomized double blind trials comparing venlafaxine and SSRIs in major depressive disorder conducted by Wyeth before 2007, whether published or not.
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