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Abstract

We appreciate the thoughtful comments of Koesters et al. ( 1 Weinmann S. Becker T. Koesters M. Re-evaluation of the efficacy and tolerability of venlafaxine vs SSRI: Meta-analysis. Psychopharmacology (Berl). 2008; 196: 511-520 Crossref PubMed Scopus (43) Google Scholar ). We were of course aware of their meta-analysis, which focused on a subset of the published studies comparing venlafaxine and various selective serotonin reuptake inhibitors (SSRIs) and regret that their report was not published in time to be available for discussion in our article. With respect to the first point raised by Koesters et al., we agree that the differences between the results of their meta-analysis and ours are small. We also agree that publication bias can distort the results of meta-analyses; this is why we included all randomized double blind trials comparing venlafaxine and SSRIs in major depressive disorder conducted by Wyeth before 2007, whether published or not. Although we do not believe that Koesters et al. intended to suggest that their strategy for study inclusion was superior to the one used in the COMPARE study (Comprehensive Analysis of Remission), we wish to clarify that all the studies included in the primary analyses of COMPARE were double-blind, randomized controlled trials and, as such, would qualify as “more rigorous studies” within most systems of scoring treatment outcome research. Regarding “Comprehensive Analysis of Remission (COMPARE) with Venlafaxine Versus SSRIs”Biological PsychiatryVol. 66Issue 5PreviewNemeroff et al. (1) present a comprehensive meta-analysis of venlafaxine versus selective serotonin reuptake inhibitor (SSRI) in the treatment of major depression and address the important question of whether there are differences in efficacy between newer antidepressants. The authors show a small but significant advantage of venlafaxine over fluoxetine in achieving remission. They report, compared with all SSRIs, a number needed to treat (NNT) of 17, which would be of public health relevance. In a recent review (2) based on published studies with more rigorous and restrictive inclusion criteria, we could not show a statistically significant advantage of venlafaxine versus SSRIs in remission rates but found only a small advantage in response rates. Full-Text PDF