Increased remission rates with venlafaxine compared with fluoxetine in hospitalized patients with major depression and melancholia

This was a 6-week, double-blind, randomized trial of the efficacy and toler ability of venlafaxine and fluoxetine in 109 patients with major depression and melancholia. Hospitalized and day care patients with DSM-IV major depr ession and melancholia and a baseline Montgomery-Asberg Depression Rating S cale (MADRS) score of greater than or equal to 25 were eligible. The doses were venlafaxine 75 mg/day or fluoxetine 20 mg/day from days 1-4, venlafaxi ne 150 mg/day or fluoxetine 40 mg/day from days 5-10, and venlafaxine 225 m g/day or fluoxetine 60 mg/day from days 11-42. The intention-to-treat analy ses included 55 patients on venlafaxine and 54 on fluoxetine. At the final evaluation, 70% of patients with venlafaxine and 66% with fluoxetine had gr eater than or equal to 50% reduction in the MADRS score, and 70% with venla faxine and 62% with fluoxetine had a Clinical Global Impression (CGI) score of 1 or 2. A CGI improvement score of 1 was observed in 51% of patients wi th venlafaxine and 32% with fluoxetine (P = 0.018). A final Hamilton Depres sion Rating Scale (HAM-D) score < 7 was attained in 41% of venlafaxine-trea ted and 36% of fluoxetine-treated patients. Overall, 22% of patients in eac h group discontinued therapy, but only 5% on venlafaxine and 9% on fluoxeti ne discontinued for adverse events. Nausea was reported in 5.5% of venlafax ine-treated patients and 14.8% of fluoxetine-treated patients. Venlafaxine was effective and well tolerated for treating inpatients with major depress ion and melancholia. Based on remission criteria (HAM-D < 7 or CGI of 1), v enlafaxine was superior to fluoxetine. (C) 2000 Lippincott Williams & Wilki ns.