ANTIDEPRESSANT EFFICACY AND CARDIOVASCULAR SAFETY OF VENLAFAXINE IN YOUNG VS OLD PATIENTS WITH COMORBID MEDICAL DISORDERS

Objective: To determine whether venlafaxine exerts a differential effe ct on blood pressure in young versus old depressed patients. Method: W e compared thirty-four consecutive patients treated with 50-250 mg/day venlafaxine for major depressive disorder or another major mood disor der at our medical college's ambulatory neuropsychiatry program. We ob tained baseline and follow-up blood pressure measurements. Each patien t also received a baseline and final Clinical Global Impressions (CGI) score; global improvement was determined by consensus of two clinicia ns. Results. Sixteen nongeriatric patients (age, 13 to 56 years) were compared with eighteen elderly patients (age, 65 to 86 years). Most pa tients (88%) had serious medical comorbidities or histories. Despite a higher mean daily venlafaxine dosage for patients in the young group, no significant changes in systolic blood pressure were noted in eithe r group. For the older group, we found a non-statistically significant 4.7 mm Hg mean increase in diastolic blood pressure. No patient becam e hypertensive. We also found a negative correlation between baseline diastolic blood pressure and change in diastolic blood pressure during treatment with venlafaxine. This inverse relationship was statistical ly significant in the older patients. Conclusions: Venlafaxine was not associated with significant, sustained changes in blood pressure in a ny patient receiving dosages of 50-250 mg/day. Minimal changes in dias tolic blood pressure were no more likely to occur in older venlafaxine -treated patients than in younger ones. Higher baseline diastolic bloo d pressure in older patients, but not in. younger ones, seemed to prot ect against diastolic adrenergic blood pressure effects of venlafaxine .