A systematic review of duloxetine and venlafaxine in major depression, including unpublished data
Abstract
Schueler Y‐B, Koesters M, Wieseler B, Grouven U, Kromp M, Kerekes MF, Kreis J, Kaiser T, Becker T, Weinmann S. A systematic review of duloxetine and venlafaxine in major depression, including unpublished data. Objective: To determine the short‐term antidepressant efficacy and tolerability of duloxetine and venlafaxine vs. each other, placebo, selective serotonin reuptake inhibitors (SSRIs), and tri‐ and tetracyclic antidepressants (TCAs) in adults with major depression. Method: Meta‐analysis of randomised controlled trials identified through bibliographical databases and other sources, including unpublished manufacturer reports. Results: Fifty‐four studies including venlafaxine arms (n = 12 816), 14 including duloxetine arms (n = 4528), and two direct comparisons (n = 836) were analysed. Twenty‐three studies were previously unpublished. In the meta‐analysis, both duloxetine and venlafaxine showed superior efficacy (higher remission and response rates) and inferior tolerability (higher discontinuation rates due to adverse events) to placebo. Venlafaxine had superior efficacy in response rates but inferior tolerability to SSRIs (OR = 1.20, 95% CI 1.07–1.35 and 1.38, 95% CI 1.15–1.66, respectively), and no differences in efficacy and tolerability to TCAs. Duloxetine did not show any advantages over other antidepressants and was less well tolerated than SSRIs and venlafaxine (OR = 1.53, 95% CI 1.10–2.13 and OR 1.79, 95% CI 1.16–2.78, respectively). Conclusion: Rather than being a first‐line option, venlafaxine appears to be a valid alternative in patients who do not tolerate or respond to SSRIs or TCAs. Duloxetine does not seem to be indicated as a first‐line treatment.
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SNRIs have better therapeutic efficacy and higher tolerability compared to commonly used antidepressants because of their impact on both norepinephrine and 5-HT.
“It has been suggested that SNRIs have better therapeutic efficacy and higher tolerability compared to commonly used antidepressants since of their impact on both norepinephrine (NE) and 5-HT.336–338”
From Epigenetic regulation in major depression and other stress-related disorders: molecular mechanisms, clinical relevance and therapeutic potential (2023) · cites this paper as [337]
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- Authors
- Schueler, Y. ‐., Koesters, M., Wieseler, B., Grouven, U., Kromp, M., Kerekes, M. F., Kreis, J., Kaiser, T., Becker, T., & Weinmann, S.
- Affiliations
- Universität Ulm (DE)
- Institute for Quality and Efficiency in Health Care (DE)
- Venue
- Acta Psychiatrica Scandinavica
- Publisher
- Wiley
- Published
- 2010-09-10
- Volume
- 123
- Issue
- 4
- Pages
- 247-265
- ISSN
- 0001-690X (ISSN-L)
- 1600-0447
- OpenAlex
- W1553904068
- Cited by
- 87
- References
- 9
- Citations by year
- 2026: 2 · 2024: 3 · 2023: 5 · 2022: 7 · 2021: 8 · 2020: 3 · 2019: 4 · 2018: 5 · 2017: 6 · 2016: 5 · 2015: 10 · 2014: 4 · 2013: 10 · 2012: 5
- FWCI
- 0.90
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Acta Psychiatrica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- Funders
- AstraZeneca
- GlaxoSmithKline
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- duloxetine, venlafaxine, major depressive disorder, antidepressant efficacy, antidepressant tolerability, selective serotonin reuptake inhibitors, tricyclic antidepressants, tetracyclic antidepressants, placebo comparison, adverse events, discontinuation rate
- MeSH terms
- Duloxetine Hydrochloride, Pharmacological Phenomena, Venlafaxine Hydrochloride, Adult, Antidepressive Agents, Tricyclic, Cyclohexanols, Major Depressive Disorder, Depressive Disorder, Major, Dose-Response Relationship, Drug, Drug Resistance, Humans, Remission Induction, Therapeutic Equivalency, Thiophenes, Randomized Controlled Trials as Topic, Treatment Outcome, Antidepressive Agents, Second-Generation
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