Results of a study published in the March 2001 issue of The British Journal of Psychiatry indicate that the use of SSRIs as a first line treatment for depression may be a thing of the past. Patients treated with the medication venlafaxine (Effexor, Effexor XR) were found to achieve remission of their depression symptoms at a rate about ten percent higher than those taking the SSRIs fluoxetine (Prozac), paroxetine (Paxil), or fluvoxamine (Luvox).
How Efficacy is Measured
A mandatory benchmark of antidepressant efficacy established by the U.S. Food and Drug Administration (FDA) is that it should reduce depressive symptoms by fifty percent. An even higher standard is what's known as "remission", or a complete return to the normal functioning a patient had prior to their symptoms. In depression studies a determination of remission is established by a score of less than seven on a seventeen-item Hamilton Rating Scale for Depression (HAM-D). Patients who achieve full remission are less likely to relapse.
This particular study was conducted by pooling the data from eight comparable randomized, double-blind studies to compare remission rates of patients with diagnosed major depressive disorder. The study consisted of 851 patients treated with Effexor XR, 748 patients treated with an SSRI (either Prozac, Paxil, or Luvox), and 446 patients treated with placebo only. Patients were treated up to eight weeks.
Significant differences in remission rates between SSRIs and venlafaxine were visible as early as week two. Significant differences in SSRIs and placebo did not develop until week four. Overall venlafaxine remission rates were forty-five percent, compared to thirty-five percent for SSRIs and twenty-five percent for placebo. Michael E. Thase, MD, professor of psychiatry at University of Pittsburgh School of Medicine, and lead author of the study, finds these results "very exciting". Says Thase, "This certainly is the strongest evidence yet that all antidepressants are not equally effective."
Why It Works Better
The difference is thought to result from the fact that Effexor attacks troubled brain chemistry with a two-pronged approach. Although SSRIs primarily work through the selective inhibition of serotonin reuptake, Effexor prevents the reuptake of norepinephrine as well as serotonin. Says Dr. Thase, "I believe the dual-action mechanism of action conveyed by venlafaxine increases the chances of patients obtaining the best treatment outcome--the ability to achieve remission. This, in turn, may enhance their chances of long-term recovery."
Is Effexor Right for You?
The final determination of whether Effexor is the right medication for you remains with your physician. Venlafaxine is approved by the FDA and thirty-three other countries to treat depression and generalized anxiety disorder (GAD). GAD, which is the most common anxiety disorder, is characterized by overwhelming, chronic and excessive worry, anxiety and tension that lasts for at least six months. If you suffer from GAD this would be a further reason to consider Effexor as your first medication choice.
Thase ME, Entsuah AR, Rudolph RL
Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors.
The British Journal of Psychiatry 2001; 178(3): 234-41.