© 2002 The Royal College of Psychiatrists
REVIEW ARTICLE |
Efficacy and tolerability of venlafaxine compared with selective serotonin reuptake inhibitors and other antidepressants: a meta-analysis*
Kaiser Center for Health Research, Portland, Oregon, USA
University of Dumfries and Galloway, Scotland
NHS Centre for Reviews and Dissemination, University of York
Department of Primary Care & General Practice, University of Birmingham
Neuroscience and Psychiatry Unit, University of Manchester, UK
Correspondence: Nick Freemantle, Department of Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. Tel: +44 (0) 121 414 7943; fax: +44 (0) 121 414 6571; e-mail: N.Freemantle{at}bham.ac.uk
Declaration of interest The study was funded by Wyeth Laboratories. D.S. has received funding on another study from Wyeth Laboratories and N.F. and I.A. have received speaker's fees and honoraria in connection with this work.
* The Editor, Greg Wilkinson, is in receipt of a consultancy fee from Neurolink (sponsored by Wyeth) so took no part in, and was kept blind to, the assessment of this paper. After enquiries by Professor Wilkinson, neither the Editorial Board member who acted as Editor in respect of this paper, nor those assessors who took part in the peer-review process, declared any interest relevant to the publication of this paper.
1 Multiple comparisons were made in a number of trials. As a quality criterion, and a rule of thumb, we cite the total number of patients in the trials, rather than the comparisons included, because there is good empirical evidence that the quality of studies is affected directly by the overall size.
Background In individual studies and limited meta-analyses venlafaxine has been reported to be more effective than comparator antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs).
Aims To perform a systematic review of all such studies.
Method We conducted a systematic review of double-blind, randomised trials comparing venlafaxine with alternative antidepressants in the treatment of depression. The primary outcome was the difference in final depression rating scale value, expressed as a standardised effect size. Secondary outcomes were response rate, remission rate and tolerability.
Results A total of 32 randomised trials were included. Venlafaxine was more effective than other antidepressants (standardised effect size was -0.14, 95% Cl -0.07 to -0.22). A similar significant advantage was found against SSRIs (20 studies) but not tricyclic antidepressants (7 studies).
Conclusions Venlafaxine has greater efficacy than SSRIs although there is uncertainty in comparison with other antidepressants. Further studies are required to determine the clinical importance of this finding.
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