Venlafaxine versus fluvoxamine in the treatment of delusional depression: A pilot double-blind controlled study

Background: Previous studies have reported the efficacy of selective seroto nin reuptake inhibitors as monotherapy in the treatment of delusional depre ssion. The clinical efficacy of venlafaxine, a serotonin-norepinephrine reu ptake blocker, has been demonstrated in the treatment of patients with mode rate-to-severe depression, but, to date, no evidence is available about its use in depressed patients with psychotic features. Method: Under double-blind conditions, 28 hospitalized patients who met DSM -IV criteria for major depression, severe with psychotic features, were ran domly assigned to receive fluvoxamine or venlafaxine, 300 mg/day, for 6 wee ks. Severity was evaluated using the Hamilton Rating Scale for Depression ( HAM-D) and the Dimensions of Delusional Experience Rating Scale (DDERS) adm inistered at baseline and every week thereafter. Side effects were also rec orded. Clinical response was defined as a reduction of the scores in the 21 -item HAM-D to 8 or below and in the DDERS to 0. Results: At study completion, the response rates were 78.6% (N = 11) and 58 .3% (N = 7) for fluvoxamine and venlafaxine, respectively. No significant d ifference was found between drugs (Fisher exact test, p = .40). Analysis of covariance on HAM-D scores did not reveal a significantly different decrea se of depressive symptomatology between the 2 treatment groups (p = .14). T reatment response appeared to be unrelated to the demographic and clinical characteristics recorded. The overall safety profile of both fluvoxamine an d venlafaxine was favorable. Conclusion: The results of this pilot double-blind trial show that fluvoxam ine is useful in the treatment of delusional depression and suggest that ve nlafaxine may also be an effective compound in the treatment of this disord er. The latter finding, although promising, warrants further replication in a larger sample of patients.