Evidence from meta- analysis of r and omised controlled trials ( RCTs ) and r and omised pragmatic trials was found in support of greater efficacy of the serotonin noradrenaline reuptake inhibitors ( SNRIs ) , venlafaxine and duloxetine , in moderate to severe depression compared to SSRIs but no evidence was found for superiority of milnacipran .
There is sufficient current evidence that demonstrates an increase in efficacy , when noradrenaline reuptake is added to serotonin ( 5-HT ) reuptake , to suggest that patients with severe depression or those who have failed to reach remission with a SSRI may benefit from treatment with a SNRI .
Selective serotonin reuptake inhibitors ( SSRIs ) are recommended as first-line pharmacological treatment for depression and are the most commonly prescribed class of antidepressants .
However , there is substantial evidence that noradrenaline has a role in the pathogenesis and treatment of depression .
This review aims to examine the evidence of including noradrenaline reuptake inhibition with serotonin reuptake inhibition with respect to increasing efficacy in the treatment of depression .
A comparative study of the efficacy of acute and continuation treatment with escitalopram versus duloxetine in patients with major depressive disorder
ABSTRACT Objective : This study evaluated the efficacy and tolerability of escitalopram and duloxetine in the treatment of major depressive disorder ( MDD ) . Research design and methods : Patients were r and omised to 24 weeks of double-blind treatment with fixed doses of escitalopram ( 20 mg ) ( n = 143 ) or duloxetine ( 60 mg ) ( n = 151 ) . The primary analysis of efficacy was an analysis of covariance ( ANCOVA ) of change from baseline to endpoint ( week 24 ) in MADRS total score ( last observation carried forward ) . Main outcome measures ; Results : At week 8 , the mean change from baseline in total MADRS score was –19.5 for patients treated with escitalopram ( n = 141 ) and –17.4 for patients treated with duloxetine ( n = 146 ) , a difference of 2.1 points ( p < 0.05 ) . At week 8 , the proportion of responders ( ≥ 50 % decrease in MADRS ) was 69 % ( escitalopram ) and 58 % ( duloxetine ) ( p < 0.05 ) and remission ( MADRS ≤ 12 ) rates were 56 % ( escitalopram ) and 48 % ( duloxetine ) ( NS ) . For the primary endpoint , the mean change from baseline in total MADRS score at week 24 was –23.4 for patients treated with escitalopram and –21.7 for patients treated with duloxetine , a difference of 1.7 points ( p = 0.055 , one-sided ) . The difference in mean change from baseline in MADRS total score favoured escitalopram at weeks 1 , 2 , 4 , 8 , 12 and 16 ( p < 0.05 ) . The overall withdrawal rates were 22 % ( escitalopram ) and 25 % ( duloxetine ) ( NS ) . The withdrawal rate due to adverse events was lower for escitalopram ( 9 % ) compared to duloxetine ( 17 % ) ( p < 0.05 ) and significantly more patients treated with duloxetine reported insomnia ( 12.6 % vs. 4.9 % ) and constipation ( 8.6 % vs. 2.8 % ) . Conclusion : Escitalopram was superior to duloxetine in acute treatment and at least as efficacious and better tolerated in long-term treatment of MDD
Evidence from meta- analysis of r and omised controlled trials ( RCTs ) and r and omised pragmatic trials was found in support of greater efficacy of the serotonin noradrenaline reuptake inhibitors ( SNRIs ) , venlafaxine and duloxetine , in moderate to severe depression compared to SSRIs but no evidence was found for superiority of milnacipran .
There is sufficient current evidence that demonstrates an increase in efficacy , when noradrenaline reuptake is added to serotonin ( 5-HT ) reuptake , to suggest that patients with severe depression or those who have failed to reach remission with a SSRI may benefit from treatment with a SNRI .
Selective serotonin reuptake inhibitors ( SSRIs ) are recommended as first-line pharmacological treatment for depression and are the most commonly prescribed class of antidepressants .
However , there is substantial evidence that noradrenaline has a role in the pathogenesis and treatment of depression .
This review aims to examine the evidence of including noradrenaline reuptake inhibition with serotonin reuptake inhibition with respect to increasing efficacy in the treatment of depression .