Comparison of extended-release venlafaxine, selective serotonin reuptake inhibitors, and tricyclic antidepressants in the treatment of depression: A meta-analysis of randomized controlled trials

The purpose of this study was to summarize and compare the clinical success rates of extended-release venlafaxine, some selective serotonin reuptake i nhibitors (SSRIs), and certain tricyclic antidepressants (TCAs). A meta-ana lytic approach was used to synthesize outcomes from published randomized co ntrolled trials involving patients scoring greater than or equal to 15 on t he Hamilton Rating Scale for Depression (HAM-D) or greater than or equal to 18 on the Montgomery-Asberg Depression Rating Scale (MADRS). Searches of t he MEDLINE(R), EMBASE(R), and International Pharmaceutical Abstracts databa ses were performed, as were searches of references from retrieved articles and reviews. Drugs included in the comparison were extended-release venlafa xine (venlafaxine-XR); the SSRIs citalopram, fluoxetine, fluvoxamine, parox etine, and sertraline; and the TCAs amitriptyline, imipramine, desipramine, and nortriptyline. Therapeutic success was defined as a 50% decrease in th e HAM-D or MADRS score. Data were extracted by 2 independent evaluators, wi th differences resolved through consensus discussions. Weighted mean succes s rates were calculated for each drug class, using a random-effects model. The resulting data represent 44 trials with 63 study arms and 4033 patients with depression. Venlafaxine-XR demonstrated a 73.7% success rate, which w as statistically significantly greater than that of the studied SSRIs (61.1 %) and TCAs (57.9%) (P < 0.001). Thus this meta-analysis of randomized cont rolled studies of patients with depression suggests that venlafaxine-XR is clinically superior in efficacy to SSRIs and TCAs. Venlafaxine-XR also had universally lower, though nonsignificant, dropout rates.