Do bupropion SR and sertraline differ in their effects on anxiety in depressed patients?

Objective: To examine the effects of bupropion sustained release (SR) and s ertraline on anxiety in outpatients with recurrent DSM-IV-defined major dep ressive disorder. Method: This retrospective analysis was conducted using pooled data from 2 identical, 8-week, acute-phase, double-blind, placebo-controlled, parallel- group studies of bupropion SR (N = 234), sertraline (N = 225), and placebo (N = 233). Symptoms of anxiety and depression were measured using the 14-it em Hamilton Rating Scale for Anxiety (HAM-A) and the 21-item Hamilton Ratin g Scale for Depression (HAM-D-21), respectively. Percentage reduction in ba seline HAM-A total score for each treatment week was calculated to determin e whether the time to onset of anxiolytic activity differed among antidepre ssant responders to each agent. Central nervous system (CNS) adverse events were tabulated. Results: Bupropion SR and sertraline. were comparably effective, both were superior to placebo in reducing depressive symptoms, and they did not diffe r in their effect on anxiety symptoms. Antidepressant responders (greater t han or equal to 50% reduction in baseline HAM-D-21 score) in both groups sh owed marked and comparable reductions in HAM-A scores (baseline to exit). T here were no differences between bupropion SR and sertraline in the median time (4 weeks) to reach a clinically significant anxiolytic effect (greater than or equal to 50% reduction in baseline HAM-A score). CNS adverse event s were comparable for bupropion SR and sertraline, except for somnolence, w hich was more common in sertraline-treated patients. Conclusion: Bupropion SR and sertraline had comparable antidepressant and a nxiolytic effects and an equally rapid onset of clinically significant anxi olytic activity. There was no difference in the activating effects between the 2 antidepressants. Selection between these 2 agents cannot be based on either anticipation of differential anxiolytic activity or differential CNS side effect profiles.