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Introduction: Selecting an Antidepressant

Published online by Cambridge University Press:  07 November 2014

Mark Zimmerman
Mark Zimmerman*
Affiliation:
Dr. Zimmerman is associate professor in the Department of Psychiatry and Human Behavior at, Brown UniversitySchool of Medicine, and is director of outpatient psychiatry at Rhode Island Hospital Bayside Medical Center, both in Providence.
*
Mark Zimmerman, MD, Rhode Island Hospital, Bayside Medical Center, 235 Plain Street, Providence, RI 02905; Tel: 401-277-0724; Fax: 401-277-0726; E-mail: [email protected].
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Extract

Four years ago, my colleagues and I published an article titled “Why isn't bupropion the most frequently prescribed antidepressant?” The goal of that article was not to advocate bupropion as the preferred agent for treating depression, but rather to stimulate discussion about how psychiatrists choose an antidepressant as well as to highlight the gap between results of efficacy studies and clinical decision making in real-world practice.

The argument in support of bupropion being the preferred antidepressant was based on three premises: all antidepressants are equally effective; adverse effects (AEs) of greatest concern to patients who take antidepressants are weight gain and sexual dysfunction; and bupropion does not cause either of these AEs. Acceptance of these three premises suggested the title of that article.

Although many reviews of the antidepressant literature, including the revised American Psychiatric Association Practice Guideline for the Treatment of Major Depressive Disorder, conclude that antidepressants are equally effective in general, several experts in the treatment of depression have suggested that medications with >1 mechanism of action may be more effective than agents that have more selective neurotransmitter effects. In a meta-analysis of eight studies comparing the remission rates in patients treated with the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine or selective serotonin reuptake inhibitors (SSRIs), Thase and colleagues demonstrated that venlafaxine was more effective than SSRIs in achieving remission in depressed patients. However, these conclusions were tentative as most of the included studies were comparisons of venlafaxine and fluoxetine; only one study included sertraline, and there were no studies of citalopram included in the review. In addition, patients who had previously failed treatment with an SSRI were not excluded, and, although patients who fail with one SSRI may respond to subsequent treatment with another SSRI, the inclusion of SSRI failures may favor venlafaxine in comparisons with SSRIs. Lastly, all of the studies included in the meta-analysis were funded by the manufacturer of venlafaxine.

Type
Research Article
Information
CNS Spectrums , Volume 14 , Issue S12 , 2009 , pp. 4 - 7
Copyright
Copyright © Cambridge University Press 2009

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References

1.Zimmerman, M, Posternak, MA, Attiullah, N, et al.Why isn't bupropion the most frequently prescribed antidepressant? J Clin Psychiatry. 2005;66(5):603–610.Google Scholar
2.Practice guideline for the treatment of patients with major depressive disorder (revision). American Psychiatric Association. Am J Psychiatry. 2000;157(4 suppl):1–45.Google Scholar
3.Lam, RW, Kennedy, SH. Evidence-based strategies for achieving and sustaining full remission in depression: focus on metaanalyses. Can J Psychiatry. 2004;49(3 suppl 1):17S–26S.Google Scholar
4.Shelton, CI. Long-term management of major depressive disorder: are differences among antidepressant treatments meaningful? J Clin Psychiatry. 2004;65(suppl 17):29–33.Google Scholar
5.Stahl, SM, Grady, MM, Moret, C, Briley, M. SNRIs: their pharmacology, clinical efficacy, and tolerability in comparison with other classes of antidepressants. CNS Spectr. 2005;10(9):732–747.Google Scholar
6.Zajecka, JM, Albano, D. SNRIs in the management of acute major depressive disorder. J Clin Psychiatry. 2004;65(suppl 17):11–18.Google Scholar
7.Thase, ME, Entsuah, AR, Rudolph, RL. Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors. Br J Psychiatry. 2001;178:234–241.Google Scholar
8.Joffe, RT, Levitt, AJ, Sokolov, ST, Young, LT. Response to an open trial of a second SSRI in major depression. J Clin Psychiatry. 1996;57(3):114–115.Google Scholar
9.Thase, ME, Blomgren, SL, Birkett, MA, Apter, JT, Tepner, RG. Fluoxetine treatment of patients with major depressive disorder who failed initial treatment with sertraline. J Clin Psychiatry. 1997;58(1):16–21.CrossRefGoogle ScholarPubMed
10.Thase, ME, Feighner, JP, Lydiard, RB. Citalopram treatment of fluoxetine nonresponders. J Clin Psychiatry. 2001;62(9):683–687.Google Scholar
11.Smith, D, Dempster, C, Glanville, J, Freemantle, N, Anderson, I. Efficacy and tolerability of venlafaxine compared with selective serotonin reuptake inhibitors and other antidepressants: a meta-analysis. Br J Psychiatry. 2002;180:396–404.Google Scholar
12.Nemeroff, CB, Entsuah, R, Benattia, I, Demitrack, M, Sloan, DM, Thase, ME. Comprehensive analysis of remission (COMPARE) with venlafaxine versus SSRIs. Biol Psychiatry. 2008;63(4):424–434.CrossRefGoogle ScholarPubMed
13.Dewan, MJ, Anand, VS. Evaluating the tolerability of the newer antidepressants. J Nerv Ment Dis. 1999;187(2):96–101.Google Scholar
14.Preskorn, SH. Comparison of the tolerability of bupropion, fluoxetine, imipramine, nefazodone, paroxetine, sertraline, and venlafaxine. J Clin Psychiatry. 1995;56(suppl 6):12–21.Google Scholar
15.Zimmerman, M, Posternak, M, Friedman, M, et al.Which factors influence psychiatrists' selection of antidepressants? Am J Psychiatry. 2004;161(7):1285–1289.Google Scholar
16.Baldomero, EB, Ubago, JG, Cercós, CL, Ruiloba, JV, Calvo, CG, López, RP. Venlafaxine extended release versus conventional antidepressants in the remission of depressive disorders after previous antidepressant failure: ARGOS study. Depress Anxiety. 2005;22(2):68–76.Google Scholar
17.de Montigny, C, Silverstone, PH, Debonnel, G, Blier, P, Bakish, D. Venlafaxine in treatment-resistant major depression: a Canadian multicenter, open-label trial. J Clin Psychopharmacol. 1999;19(5):401–406.Google Scholar
18.Kaplan, EM. Efficacy of venlafaxine in patients with major depressive disorder who have unsustained or no response to selective serotonin reuptake inhibitors: an open-label, uncontrolled study. Clin Ther. 2002;24(7):1194–1200.Google Scholar
19.Mbaya, P. Safety and efficacy of high dose of venlafaxine XL in treatment resistant major depression. Hum Psychopharmacol. 2002;17(7):335–339.CrossRefGoogle ScholarPubMed
20.Mitchell, PB, Schweitzer, I, Burrows, G, Johnson, G, Polonowita, A. Efficacy of venlafaxine and predictors of response in a prospective open-label study of patients with treatment-resistant major depression. J Clin Psychopharmacol. 2000;20(4):483–487.Google Scholar
21.Poirier, MF, Boyer, P. Venlafaxine and paroxetine in treatment-resistant depression. Double-blind, randomised comparison. Br J Psychiatry. 1999;175:12–16.Google Scholar
22.Rush, AJ, Trivedi, MH, Wisniewski, SR, et, al, and the STAR*D Study Team. Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression. N Engl J Med. 2006;354(12):1231–1242.CrossRefGoogle ScholarPubMed
23.Sáiz-Ruiz, J, Ibáñez, A, Díaz-Marsá, M, et al.Efficacy of venlafaxine in major depression resistant to selective serotonin reuptake inhibitors. Prog Neuropsychopharmacol Biol Psychiatry. 2002;26(6):1129–1134.Google Scholar
24.Schweitzer, I, Burrows, G, Tuckwell, V, et al.Sustained response to open-label venlafaxine in drug-resistant major depression. J Clin Psychopharmacol. 2001;21(2):185–189.Google Scholar
25.Whyte, EM, Basinski, J, Farhi, P, et al.Geriatric depression treatment in nonresponders to selective serotonin reuptake inhibitors. J Clin Psychiatry. 2004;65(12):1634–1641.Google Scholar
26.Nierenberg, AA, Feighner, JP, Rudolph, R, Cole, JO, Sullivan, J. Venlafaxine for treatment-resistant unipolar depression. J Clin Psychopharmacol. 1994;14(6):419–423.Google Scholar
27.Petersen, T, Dording, C, Neault, NB, et al.A survey of prescribing practices in the treatment of depression. Prog Neuropsychopharmacol Biol Psychiatry. 2002;26(1):177–187.Google Scholar
28.Khan, A, Leventhal, RM, Khan, SR, Brown, WA. Severity of depression and response to antidepressants and placebo: an analysis of the Food and Drug Administration database. J Clin Psychopharmacol. 2002;22(1):40–45.Google Scholar
29.Zimmerman, M, Chelminski, I, Posternak, MA. Generalizability of antidepressant efficacy trials: differences between depressed psychiatric outpatients who would or would not qualify for an efficacy trial. Am J Psychiatry. 2005;162(7):1370–1372.Google Scholar
30.Papakostas, GI, Stahl, SM, Krishen, A, et al.Efficacy of bupropion and the selective serotonin reuptake inhibitors in the treatment of major depressive disorder with high levels of anxiety (anxious depression): a pooled analysis of 10 studies. J Clin Psychiatry. 2008;69(8):1287–1292.Google Scholar
31. Pristiq [package insert]. Philadelphia, PA: Wyeth Pharmaceuticals, Inc; 2008.Google Scholar
32.Boyer, P, Montgomery, S, Lepola, U, et al.Efficacy, safety, and tolerability of fixed-dose desvenlafaxine 50 and 100 mg/day for major depressive disorder in a placebo-controlled trial. Int Clin Psychopharmacol. 2008;23(5):243–253.Google Scholar
33.Liebowitz, M, Manley, AL, Padmanabhan, SK, Ganguly, R, Tummala, R, Tourian, KA. Efficacy, safety, and tolerability of desvenlafaxine 50 mg/d and 100 mg/d in outpatients with major depressive disorder. Curr Med Res Opin. 2008;24(7):1877–1890.Google Scholar