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 double-blind comparison of escitalopram and venlafaxine extended release in the treatment of major depressive disorder.
BACKGROUND Escitalopram is the most selective serotonin reuptake inhibitor ( SRI ) antidepressant available . Venlafaxine is a non-selective SRI that also inhibits noradrenergic re-uptake . This study compared escitalopram and venlafaxine extended release ( XR ) in depressed out patients at the highest doses recommended in the United States . METHOD In this r and omized trial , patients ( diagnosis of DSM-IV-defined major depressive disorder ; baseline Hamilton Rating Scale for Depression score of > /= 20 ) received 1 week of single-blind placebo treatment , followed by 8 weeks of double-blind , fixed-dose treatment with either escitalopram or venlafaxine XR ( rapidly titrated to 20 mg/day and 225 mg/day , respectively , in accordance with prescribing information ) . The primary efficacy variable was change from baseline to week 8 in Montgomery-Asberg Depression Rating Scale ( MADRS ) total score . Data were collected from May to December 2002 . RESULTS Mean baseline MADRS scores for the escitalopram ( N = 97 ) and venlafaxine XR ( N = 98 ) groups were 30.7 and 30.0 , respectively . There were no significant differences in measures of efficacy between the 2 antidepressants . Mean changes from baseline to endpoint in MADRS total score for escitalopram and venlafaxine XR were -15.9 and -13.6 , respectively . Remission ( MADRS score of < /= 10 ) rates at endpoint were 41.2 % for escitalopram and 36.7 % for venlafaxine XR . Response ( > /= 50 % reduction from baseline MADRS score ) rates for the escitalopram and venlafaxine XR groups were 58.8 % and 48.0 % , respectively . Tolerability measures favored escitalopram over venlafaxine XR treatment . The venlafaxine XR group had a higher incidence than the escitalopram group of treatment-emergent adverse events ( 85.0 % vs. 68.4 % ) and discontinuation due to adverse events ( 16.0 % vs. 4.1 % ; p < .01 ) . CONCLUSION Results of this study indicate that , when titrated rapidly to their maximum recommended doses , escitalopram is at least as effective as venlafaxine XR and significantly better tolerated . These results do not support the hypothesis that nonselective SRIs have greater efficacy than selective SRIs
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 .