Efficacy Of Venlafaxine Research Articles

VE-MMODE – A randomized controlled trial of Venlafaxine versus Escitalopram for treatment of mild to moderate depression in persons with epilepsy

ObjectivesDepression in persons with epilepsy (PWE) goes undiagnosed and untreated. Despite being common, there are no direct efficacy comparisons of available antidepressants in PWE. Our aim was to compare the effectiveness of Venlafaxine (VEN) and Escitalopram (ESCIT) in comorbid depression in PWE. MethodsIn a single-center, prospective, double-blinded randomized controlled trial (RCT) 90 PWE (age ≥18 years) with mild to moderate depression, were randomized in a 1:1 ratio to receive ESCIT (5–20 mg/day) or VEN (37.5–150 mg/day) for 8 weeks. The primary outcome was to study differences in the efficacy, based on the change in scores of the Hamilton depression rating scale (HAM-D) at 8 weeks. Seizure frequency, QOLIE-31, adverse event profile, and medication adherence were secondary outcome measures. ResultsUsing the NDDI-E scale, we screened 350 PWE, 90 were enrolled. ITT analysis included all participants and the PP analysis included 40 participants to VEN group and 42 to ESCIT group. Baseline mean (±SD) HAM-D scores for both groups were similar (13.53 ± 3.27; 13.02 ± 3.57). The mean difference (95%CI) on HAM-D scores at 8 weeks was found to be significant within both groups (ITT/PP- VEN: 7.75(6.75, 8.79)/7.92 (7.06, 8.78); p < 0.001, ESCIT: 8.21 (7.39, 9.03)/8.23(7.43, 9.04); p < 0.001). However, there was no significant difference in the efficacy of VEN versus ESCIT at 8 weeks. A significant improvement in QOLIE-31 index and seizure frequency was observed from baseline in both the groups. 90% of those on VEN and 92.9% of those using ESCITadhered to the treatment at week 8. Adverse events were more in VEN group than the ESCIT group. ConclusionsThis study found that HAMD scores improved significantly in the ESCIT and VEN groups, despite the fact that there was no clinically meaningful difference observed between the two groups. Trials with a larger sample size and longer duration are required to establish whether ESCIT or VEN is superior.

A Comparison Between the Efficacy of Venlafaxine and Duloxetine in Improving Chemotherapy-Induced Chronic Neurotoxicity in Cancer Patients

Background: Chemotherapy-induced peripheral neuropathy is one of the most common side effects of chemotherapy. This study aimed to determine the effectiveness of venlafaxine and duloxetine in improving chronic neurotoxicity induced by chemotherapy in cancer patients. Materials and Methods: The study was performed on cancer patients undergoing outpatient chemotherapy or hospitalization in Rasoul Akram hospital. The admitted patients were blindly divided into two groups. The first group was treated with venlafaxine, and the second group was treated with duloxetine. The treatment lasted up until the patients’ full recovery up to 10 weeks. Different intensities of the patients’ neuropathy were measured on all days of treatment based on NCI Common Terminology Criteria for Adverse Events (CTCAE) v 3.0 criteria. At the end of the treatment, the side effects of venlafaxine and duloxetine were identified. Results: A total of 30 patients in two groups (n=15 for each group) were treated with venlafaxine and duloxetine. There was no significant difference between the two groups in terms of age and gender. The severity of neuropathy was significantly reduced in the venlafaxine compared to the duloxetine group from 7 to 10 weeks. The results indicated that 75% and 85.7% fall asleep in the venlafaxine group and the duloxetine group, respectively. Further, there was no significant difference between the two groups in terms of drug side effects. Conclusion: This study showed that venlafaxine is a suitable drug for the treatment of chronic neurotoxicity in patients with relatively fewer side effects compared to other used drugs. Although these results require further prospective studies due to the small sample size, future drug regimens may preferably contain venlafaxine.

Efficacy and Safety of Venlafaxine Versus Amitriptyline in Decreasing Severity and Frequency of Migraine Attacks: A Randomized Controlled Trial

Objective: To compare the safety and efficacy of two anti-migraine Venlafaxine and Amitriptyline in migraine prophylaxis. Background of the study: The efficacy of Venlafaxine and Amitriptyline on various headache disorders has been proved in previous studies. This Open-Label Parallel group study of 12 weeks compares the safety and efficacy of Venlafaxine and Amitriptyline in migraine prophylaxis. Methods: 100 migraine patients were randomized and they were allocated equally to Venlafaxine XR and Amitriptyline group. The frequency, duration, severity of headache attacks and safety profiles were monitored for 3 months. Patient satisfaction and global tolerance were also evaluated during this period. Results: The statistical difference between the treatment groups in the number of headache attacks (p = 0.012) the duration of attacks (p=0.046) and the severity of the attacks (p=0.032) was notable at the end of the study period with Venlafaxine better than Amitriptyline. Side effects like hypersomnia and constipation were reported in both the groups. Analgesic consumption was also significant reduced in Venlafaxine group when compared with Amitriptyline (p=0.021). Venlafaxine has higher patient satisfaction when compared to Amitriptyline. Global efficacy and global tolerance were also higher in the Venlafaxine group. Conclusions: The results support the safety and efficacy profile of Venlafaxine as preventive therapy for migraine.

The efficacy of venlafaxine in the treatment of depression, withdrawal symptoms, and craving in individuals with methamphetamine dependence

ABSTRACT Background Currently, there is no confirmed drug intervention in the treatment of methamphetamine (MA) dependence. In the present study, we tested the possible influence of venlafaxine in individuals with MA dependence. Methods A total of 52 male patients (mean age: 33.93 years) diagnosed with MA dependence referred to Farabi Hospital in Kermanshah, Iran, was randomly assigned either to enlafaxine or a placebo condition. At the baseline, as well as 4 to 8 weeks later, patients completed questionnaires on depression, withdrawal symptoms, and cravings. Results The mean scores of withdrawal symptoms (hyperarousal, anxiety, reversed vegetative), depression, and cravings (desire & intention, negative reinforcement, and control) during the study and in both groups had a descending trend. Unlike the effect of the studied groups, the effect of time on the repeated measure model was significant. The mean of inverse symptoms, desire, and control from the fourth week to the end of the study did not have a statistically significant difference. Conclusion The results showed that venlafaxine can be effective in reducing depression, withdrawal symptoms, and cravings in people who are dependent on MA, though these results were observed in parallel in the placebo group, and as such warrants further study.

Pharmacotherapy of fibromyalgia – current knowledge

Fibromyalgia is a chronic pain syndrome, which affects 2–4% of the general population. Despite its substantial prevalence in the community, the underlying pathophysiology of fibromyalgia remains largely unknown, and the diagnosis is made using symptom-based criteria. As a result, patients may be classified as suffering from fibromyalgia in spite of differing in the pathogenesis of their complaints. Therefore it is no surprise, that the efficacy of pharmacotherapy of fibromyalgia remains limited. This work aims to provide a summary of current knowledge based on trials which assessed the efficacy of fibromyalgia pharmacotherapy. The drugs with the highest amount of research proving their efficacy in reducing fibromyalgia symptoms are duloxetine, milnacipran, pregabalin and amitriptyline. Studies documenting the efficacy of venlafaxine, gabapentin and antidepressants other than serotonin and noradrenalin reuptake inhibitors are smaller in number. Data obtained in trials verifying the effects of selective serotonin reuptake inhibitors, tramadol or cannabinoids are too sparse to draw any clear conclusions. There are reports indicating that opioids (other than tramadol) are contradicted in fibromyalgia, the use of selective serotonin reuptake inhibitors seems disputable too, due to the risk of inducing a change in the pain phenotype. There is a lack of data suggesting the efficacy of nonsteroid anti-inflammatory drugs in fibromyalgia. Furthermore, there are individual studies showing beneficial effects of other drugs and dietary supplements or combinations thereof in patients with fibromyalgia. In summary, the obtained data show that the amount of medicines whose efficacy in fibromyalgia has been verified in numerous studies is limited. More studies exploring the pathophysiology of fibromyalgia and trials verifying the effects of pharmacotherapy are needed to achieve the optimal efficacy of fibromyalgia pharmacotherapy.

CYP2D1 Gene Knockout Reduces the Metabolism and Efficacy of Venlafaxine in Rats.

Rat CYP2D1 has been considered as an ortholog of human CYP2D6 To assess the role of CYP2D1 in physiologic processes and drug metabolism, a CYP2D1-null rat model was generated with a CRISPR/Cas9 method. Seven base pairs were deleted from exon 4 of CYP2D1 of Sprague-Dawley wild-type (WT) rats. The CYP2D1-null rats were viable and showed no abnormalities in general appearance and behavior. The metabolism of venlafaxine (VLF) was further studied in CYP2D1-null rats. The V max and intrinsic clearance of the liver microsomes in vitro from CYP2D1-null rats were decreased (by ∼46% and ∼57% in males and ∼47% and ∼58% in females, respectively), while the Michaelis constant was increased (by ∼24% in males and ∼25% in females) compared with WT rats. In the pharmacokinetic studies, compared with WT rats, VLF in CYP2D1-null rats had significantly lower apparent total clearance and apparent volume of distribution (decreased by ∼36% and ∼48% in males and ∼23% and ∼25% in females, respectively), significantly increased area under the curve (AUC) from the time of administration to the last time point, AUC from the start of administration to the theoretical extrapolation, and C max (increased by ∼64%, ∼59%, and ∼26% in males and ∼43%, ∼35%, and ∼15% in females, respectively). In addition, O-desmethyl venlafaxine formation was reduced as well in CYP2D1-null rats compared with that in WT rats. Rat depression models were developed with CYP2D1-null and WT rats by feeding them separately and exposing them to chronic mild stimulation. VLF showed better efficacy in the WT depression rats compared with that in the CYP2D1-null rats. In conclusion, a CYP2D1-null rat model was successfully generated, and CYP2D1 was found to play a certain role in the metabolism and efficacy of venlafaxine. SIGNIFICANCE STATEMENT: A novel CYP2D1-null rat model was generated using CRISPR/Cas9 technology, and it was found to be a valuable tool in the study of the in vivo function of human CYP2D6. Moreover, our data suggest that the reduced O-desmethyl venlafaxine formation was associated with a lower VLF efficacy in rats.

Venlafaxine pharmacogenetics:a comprehensive review.

Antidepressant response could be from 42 to 50% genetically determined. Venlafaxine (VEN) was the sixth most-prescribed antidepressant in the USA in 2017. Therefore, we reviewed studies which focused on the pharmacogenetics of VEN and found that there is a lack of guidelines for pharmacogenetic testing for VEN. Within investigated genetic polymorphisms, few of them can be indicated as potential predictors of VEN efficacy and tolerance. However, additional pharmacogenetic studies of VEN should be performed to reproduce already obtained results or explain contradictory ones. The individualization of pharmacotherapy is a key issue in providing patients with the highest possible quality of treatment,therefore pharmacogenetic studies should be one of the components of therapy optimization.

Эффективность венлафаксина при хроническом болевом синдроме

Эффективность венлафаксина при хроническом болевом синдроме

The Efficacy of Venlafaxine, Flunarizine, and Valproic Acid in the Prophylaxis of Vestibular Migraine.

Different types of medications are currently used in vestibular migraine (VM) prophylaxis, although recommendations for use are generally based on expert opinion rather than on solid data from randomized trials. We evaluated the efficacy and safety of venlafaxine, flunarizine, and valproic acid in a randomized comparison trial for VM prophylaxis. Subjects were randomly allocated to one of three groups (venlafaxine group, flunarizine group, and valproic acid group). To assess the efficacy of treatment on vertigo symptoms, the following parameters were assessed at baseline and 3 months after treatment: Dizziness Handicap Inventory (DHI) scores, number of vertiginous attacks in the previous month, and Vertigo Severity Score (VSS). Adverse events also were evaluated. A decrease in DHI total scores was shown following treatment with all three medications, with no obvious differences between the groups. Treatment effects differed, however, in the DHI physical, functional, and emotional domains with only venlafaxine showing a decreased effect in all of three domains. Flunarizine and valproic acid showed an effect in only one DHI domain. Venlafaxine and flunarizine showed decreased VSS scores (p = 0 and p = 0.03, respectively). Although valproic acid had no obvious effect on VSS (p = 0.27), decreased vertigo attack frequency was observed in this group (p = 0). Venlafaxine also had an effect on vertigo attack frequency (p = 0), but flunarizine had no obvious effect (p = 0.06). No serious adverse events were reported in the three groups. Our data confirm the efficacy and safety of venlafaxine, flunarizine, and valproic acid in the prophylaxis of VM, venlafaxine had an advantage in terms of emotional domains. Venlafaxine and valproic acid also were shown to be preferable to flunarizine in decreasing the number of vertiginous attacks, but valproic acid was shown to be less effective than venlafaxine and flunarizine to decrease vertigo severity. ChiCTR-OPC-17011266 (http://www.chictr.org.cn/).

The Catechol-O-methyltransferase Val(108/158)Met Genetic Polymorphism cannot be Recommended as a Biomarker for the Prediction of Venlafaxine Efficacy in Patients Treated in Psychiatric Settings.

The antidepressant venlafaxine is known to increase the turnover of cerebral monoamines, which are catabolized by the catechol-O-methyltransferase (COMT). The COMT (Val(108/158)Met, rs4680) genetic polymorphism affects the cerebral COMT activity. But whether this genetic polymorphism is associated with response to venlafaxine remains unclear. We assessed the impact of the COMT Val(108/158)Met, rs4680 genetic polymorphism on the efficacy of venlafaxine in depressed patients. This study was nested in the METADAP cohort, a real-world naturalistic treatment study in psychiatric settings. A total of 206 Caucasian patients with a unipolar major depressive episode (DSM-IVTR) treated with venlafaxine and evaluated with the Hamilton Depression Rating Scale (HDRS) were studied. One hundred and eighty patients were genotyped for the COMT Val(108/158)Met, rs4680 genetic polymorphism and classified into three genotype subgroups: Val/Val, Val/Met and Met/Met. The COMT genotype was the explanatory variable, and the variables to be explained were HDRS score, HDRS score improvement over time, response rate and remission rate. Venlafaxine had a trend to higher efficacy in the Val/Val patients as compared to Met/Met carriers, as shown by the HDRS score improvement after 3months of treatment, but this result was not significant in mixed models [Val/Val: 59.78% (±22.4); Val/Met: 51.64% (±26.3); Met/Met: 39.52% (±27.6)]. The percentage of responders and remitters after 3months of treatment was not significantly different in the three genotype groups, although coherent trends were shown. The COMT Val(108/158)Met, rs4680 genetic polymorphism cannot be recommended as a biomarker for the prediction of venlafaxine efficacy in patients treated in psychiatric settings.

Should a routine genotyping of CYP2D6 and CYP2C19 genetic polymorphisms be recommended to predict venlafaxine efficacy in depressed patients treated in psychiatric settings?

The antidepressant venlafaxine (VEN) is metabolized by CYP2D6 and CYP2C19. The aim of this study was to assess the relevance of generalizing to daily practice the genotyping of CYP2D6 and CYP2C19 to predict VEN efficacy in depressed patients treated in psychiatric settings. This study was nested in a naturalistic cohort, with 206 patients requiring a new antidepressant treatment and genotyped for CYP2D6 *3, *4, *5 del, *6, *2xN, *10, *41 and CYP2C19 *2, *3, *4, *5, *17 alleles. CYP2D6 and CYP2C19 phenotypes were associated neither with the Hamilton depression rating scale score improvement, nor with response and remission. Routine CYP2D6 and CYP2C19 genotyping cannot be recommended to predict VEN efficacy in depressed patients treated in psychiatry settings.

A meta-analysis of the efficacy of venlafaxine extended release 75–225 mg/day for the treatment of major depressive disorder

Objective: To evaluate the short-term efficacy of venlafaxine extended release (ER) 75–225 mg/day compared with placebo for treating major depressive disorder (MDD) and to examine associations between baseline characteristics and efficacy outcomes in MDD patients treated with venlafaxine ER 75–225 mg/day.Research design and methods: This meta-analysis included published and unpublished short-term, double-blind, placebo-controlled, Wyeth/Pfizer sponsored studies of venlafaxine ER at doses up to 225 mg/day in adults with MDD.Clinical trial registration: All trials were conducted before trial registration became mandatory.Main outcome measures: Change from baseline in the 17-item Hamilton Rating Scale for Depression (HAM-D17) total score was analyzed over time using a mixed-effects model for repeated measures with terms for study, treatment group, visit, interaction between treatment group and visit, and baseline score as a covariate. Associations between baseline demographic and clinical characteristics and the probability of HAM-D17 response and remission at week 8 were evaluated using logistic regression models, with terms for study, treatment group, and baseline characteristics in the models. Safety and tolerability was assessed based on adverse events (AEs) and discontinuations due to AEs.Results: The full analysis set included 1087 patients from five studies that fulfilled selection criteria. Statistically significant separation between venlafaxine ER and placebo groups for HAM-D17 total score was seen at week 2 and all subsequent assessments (p-values <.0001). There was no significant interaction between treatment and baseline HAM-D17 total score. Probability of HAM-D17 remission at week 8 decreased with increasing baseline HAM-D17 total score (p = .0012; OR: 0.94); however, baseline HAM-D17 total score did not predict response. Discontinuations due to AEs were reported for 9.4% of venlafaxine-ER-treated patients compared with 3.6% of placebo-treated patients.Key limitations: Five studies met the criteria for inclusion. Several differences in design between included studies limited the analysis: one study did not include a week 3 assessment (the week 3 time point was therefore dropped from the analysis), one study had two venlafaxine ER dose arms, which were combined into one group for the meta-analysis, and mixed- and flexible-dose studies were pooled.Conclusions: Venlafaxine ER 75–225 mg/day effectively reduced symptoms of depression in patients with MDD overall and in patients with either lower (≤23) or higher (>23) HAM-D17 total score at baseline.

Venlafaxine in the Treatment of Moderate and Severe Depression: Approaches to Increasing Treatment Efficacy

Objective. TO identify the factors influencing the efficacy of venlafaxine in moderate and severe depression. Materials and methods. An observational study was performed in the conditions of real clinical practice. A total of 62 patients with depression (21 men and 41 women, aged 19–61 years) treated with venlafaxine were studied. Treatment was continued for 84 days (initially in hospital and then in out-patient conditions). The initial venlafaxine dose was 75 mg/day and the mean therapeutic dose was 225 mg/day. Patients’ status was evaluated using a clinical psychopathological approach method and various scales – (MADRS, Beck scale, CGI, UKU). Results and conclusions. Study drug was found to display high efficacy in the treatment of severe and moderate depression. Venlafaxine was most effective in the treatment of anxious depression and least effective in hypochondriac depression. Use of rapidly increasing doses in the treatment of severe and moderate depression generated treatment responses in shorter periods of time without reducing the tolerance of the agent.

Efficacy of Venlafaxine (Velaxin) in the Treatment of Depression: Results of Recent Trials

Translated from Zhurnal Nevrologii i Psikhiatrii imeni S. S. Korsakova, Vol. 113, No. 11, Iss. II, Depression, pp. 79–81, November, 2013.

Association of CYP2D6 gene polymorphism and therapeutic efficacy of venlafaxine on depression in southern region of Fujian

Objective To explore the effect of CYP2D6 gene polymorphism on blood concentration, therapeutic efficacy and adverse effects of anti-depression drug venlafaxine. Methods 69 cases of patients with depression were selected randomly from southern region of FuJian, China. The blood concentration of venlafaxine was detected by HPLC, and the CYP2D6 genotype was determined by sequencing with the amplified PCR products from peripheral blood DNA. The therapeutic efficacy and adverse effects of venlafaxine were evaluated by Hamilton depression scale(HAMD) and treatment emergent symptom scale(TESS) respectively. Results Subjects was divided into CC, CT, TT three groups based on rs16947 locus genotyping. The blood concentrations of venlafaxine were (157.35±15.63)ng/ml, (70.17±5.11)ng/ml, (115.72±10.2)ng/ml respectively and there was no significant difference (F=1.257, P=0.301). The dose-corrected concentrations and normalized concentrations were not significantly different (F=1.683, 1.547, P>0.05). Similarly, the reduction rate of HAMD (CC: (40.6±7.23)%, CT: (51.7±7.09)%, TT: (42.8±14.1)%) and TESS scores (CC: 1.3±0.21, CT: 1.3±0.36, TT: 1.2±0.28) were not significantly different either (P>0.05). In 69 samples in this study, genotyping of rs3892097 locus only found GG type, and no further examination was performed. Genotyping divided rs1065852 locus into CC, CT, TT three groups. The blood concentrations of venlafaxine were (42.87±9.9)ng/ml, (64.25±13.59)ng/ml, (181.56±14.15)ng/ml respectively, and there was significant difference among the three groups (F=4.893, P=0.016). The dose-corrected concentrations and normalized concentrations were also significantly different (F=3.985, 3.648, P<0.05). The reduction rate of HAMD (CC: (42.6±8.23)%, CT: (48.8±10.8)%, TT: (63.4±9.15)%) was not significantly different (F=2.961, P=0.07). The difference of TESS scores was similar to that of HAMD reduction rate. Conclusion Among the 3 loci studied, only rs1065852 locus within CYP2D6 gene can affect its enzyme activity and then influence the therapeutic efficacy and adverse effects of venlafaxine. Key words: Venlafaxine; CYP2D6; Gene polymorphism; Blood concentration

Research on association of BDNF gene Val66Met polymorphism with efficacy of antidepressants and plasma BDNF level

To assess the association of BDNF gene Val66Met polymorphism with efficacy of antidepressant treatment and plasma BDNF level. Two hundred and forty-nine ethnic Han Chinese patients with depression(study group), who have met the diagnostic criteria of DSM-IV, were prescribed with venlafaxine or paroxetine. Two hundred and two healthy individuals were recruited as the control group. General demographic information such as gender, age, educational status, occupation, and marriage status were collected. HAMD-17 was adopted as the primary rating tool to evaluate the severity of depression on the baseline and at the end of 1st, 2nd, 4th, 6th week of treatment. PCR-restriction fragment length polymorphism was applied to determine the Val66Met polymorphism of the BDNF gene in the two groups. Plasma BDNF concentration was measured with ELISA before and after 6 weeks of treatment. No significant differences have been found in HAMD scores and reduction of HAMD scores on the baseline and at the end of 1 st, 2nd, 4th, 6th weeks of treatment for each genotype. Nor were significant differences found in the Val66Met genotypes and allelic frequency between patients who achieved remission or not after 6 weeks' treatment as well as the healthy volunteers. The plasma BDNF level in depression patients was lower than that in healthy controls. The BDNF level has increased significantly after 6 weeks' treatment with both venlafaxine and paroxetine, but was still lower than the healthy controls. The BDNF level in the patients achieved remission who were treated with venlafaxine was similar to the normal controls, while those treated with paroxetine was still lower than normal controls. The BDNF level in patients who have not achieved remission was lower than normal controls. The BDNF level was not associated with the Val66Met polymorphism on the baseline and the end of 6th week. No association has been found between the efficacy of venlafaxine or paroxetine and the BDNF Val66Met polymorphism. The BDNF level of patients with depression is significantly lower than healthy controls on the baseline, and can be enhanced with the treatment. Particularly, the BDNF level in patients who achieved remission after the treatment of venlafaxine can rise to normal. The level of BDNF has certain value in the forecasting of efficacy in the anti-depression therapy. BDNF level is not associated with the Val66Met polymorphism of the BDNF gene.

Levels of interlukin-2, interlukin-6 and its soluble receptors in the first episode depression of Uygur patients before and after treatment with venlafaxine

Objective To investigate the action of interlukin-2(IL-2), interlukin-6(IL-6) and its soluble receptors(sIL-2R, sIL-6R) in the first episode of depression in the patients of Uyghur nationality and the differences in IL-2, IL-6 and sIL-2R, sIL-6R levels between the responsive depressed patients and the refractory depressed patients treated with venlafaxine. Methods A case-control study design was conducted.57 first-episode patients with depression (patient group) and 55 healthy people matched with gender and age (control group) were recruited in the study.An intervention with sustained-releasing venlafaxine tablets at fixed dose of 150 mg/d was performed in the patient group.The severity of the illness was evaluated by using the Hamilton's depression scale (HAMD-17) before and after the therapy.And by calculating the reduction rate of HAMD-17 (≥ 50% or <50%), the patients were divided into the responsive or refractory groups.The serum levels of IL-2, IL-6, sIL-2R and sIL-6R in patients and controls were tested by ELISA, and a re-test was done with the patients after treatment. Results There were statistical significant differences of the levels of serum IL-2, IL-6 and sIL-2R, sIL-6R between the patients and the control group (P 0.05). There were positive correlations between HAMD, serum IL-2(r=0.677; P=0.000) and IL-6(r=0.197; P=0.033)before treatment in all patients. Conclusion Serum IL-2 and IL-6 may play a role in the onset of the depression.The efficacy of venlafaxine is negatively correlated with the levels of serum IL-2 and IL-6.Regulating the imbalanced inflammatory cytokines and the immune system may be one of the mechanisms of drug therapy of depression. Key words: Depression; Antidepressant; Interleukin-2; Interleukin-6

Psychomotor depressive symptoms may differentially respond to venlafaxine

Predicting differential antidepressant efficacy remains an elusive goal in major depressive disorder (MDD). The aims of this study were three-fold. Firstly, to examine if psychomotor retardation symptoms (item 8 on the 17-item Hamilton Depression Rating Scale) improve preferentially to venlafaxine (VEN) over escitalopram (ESC) treatment. Secondly, whether the 18 item CORE psychomotor signs scale predicted antidepressant remission. Finally, to investigate the role of two norepinephrine transporter gene (NET) polymorphisms (rs2242446 and rs5569) on antidepressant efficacy. Adults with Diagnostic and Statistical Manual of Mental Disorders, 4th ed. MDD (n=113) were treated with ESC or VEN prospectively for 8 weeks and rated serially with the Hamilton Depression Rating Scale. In a subsample (n=51) of patients from one of the three recruitment sites, the CORE psychomotor signs scale was also administered at baseline. Participants treated with VEN had significantly greater reduction in psychomotor retardation symptoms than those treated with ESC. The CORE scale did not predict antidepressant response or remission. Neither NET polymorphism moderated antidepressant efficacy. Findings suggest possible preferential utility of a selective serotonin and noradrenaline reuptake inhibitor in cases of MDD presenting with greater psychomotor retardation. The moderate to small sample size makes a type II error risk possible, and the negative findings need to be interpreted with caution. The positive finding of preferential efficacy of VEN for psychomotor retardation symptoms has potential translational utility.

Pharmacoeconomic evaluation of venlafaxine compared with citalopram in generalized anxiety disorder

Pharmacoeconomic evaluation aims to investigate the selection and use of drugs to make patient medication efficient, safe and economical. In this study, a pharmacoeconomic evaluation was performed to assess two treatments for generalized anxiety disorder (GAD). A total of 100 outpatients with GAD were enrolled. The patients were divided into the following two groups according to treatment program: the venlafaxine group (n=50) and the citalopram group (n=50). The patients in the venlafaxine group received 75 mg of orally administered venlafaxine and 50 mg of sulpiride once a day for the first seven days and thereafter only 150 mg of venlafaxine once a day. The patients in the citalopram group received 10 mg of citalopram and 50 mg of sulpiride orally once a day for the first seven days and thereafter only 20 mg once a day. The treatment period for the two groups was three months. Follow-up was conducted at the end of weeks 2, 4 and 12 to evaluate drug efficacy, quality of life and drug side-effects. Moreover, the two groups were scored according to cost-effectiveness analysis. Using the SF-36 Scale, the quality of life score of the patients in the venlafaxine group was observed to be significantly higher compared with that of the patients in the citalopram group at the end of weeks 4 and 12 (P<0.05). The reduction rates of the Hamilton Anxiety (HAMA) scale show that the efficacy of venlafaxine was significantly better than that of citalopram by the end of week 12. The findings of this study suggest that venlafaxine is more cost-effective than citalopram in the treatment of outpatients with GAD.

Effects of apolipoprotein E genetic polymorphism on susceptibility of depression and efficacy of antidepressants

To assess the effects of apolipoprotein E (APOE) polymorphism on the susceptibility of depression and the efficacy of antidepressants. A total of 275 patients with depression, who met the diagnostic criteria of both CCMD-3 and DSM-4, were randomly assigned into venlafaxine group (n=136)and paroxetine group(n=139). Another 202 healthy subjects were enrolled as the control group. Hamilton Rating Scale for Depression (HAMD)-17 was adopted as the primary rating instrument to evaluate the severity of depression on the baseline and the end of the 1st, 2nd, 4th, 6th week after treatment, respectively. HAMD scores ≤7 was defined as remission, and the reduction of HAMD scores ≥50% was defined as response while <50% was defined as invalid. PCR-restriction fragment length polymorphisms (PCR-RFLP) was applied to detect the genetic polymorphism of the APOE in the case groups and control group. In the venlafaxine group, the remission rate was 52.9%(n=72), the response rate was 26.5%(n=36), and the invalid rate was 20.6%(n=28), whereas the corresponding data in the paroxetine group wee 42.4%(n=59), 31.7%(n=44), and 25.9% (n=36), respectively. There were no significant differences in the efficacy between the two groups(p>0.05). In the venlafaxine group, there were no significant differences in the genotypes and the allele distribution frequency of APOEΕ2/Ε3/Ε4 between the remitters, nonremitters, and healthy controls at the end of the 6th week(p>0.05), but there was significant differences in the allele distribution frequency between the nonremitters and healthy controls(p=0.02). In paroxetine group, there were no significant differences in the genotypes and the allele distribution frequency of APOEΕ2/Ε3/Ε4 among the remitters, nonremitters and healthy controls at the end of the 6th week(p>0.05), but there were significant differences in the allele distribution frequency between the nonremitters and healthy controls (p=0.04); in addition, there were also significant differences in Ε2/Ε3 and Ε4 allele between the two groups (p=0.014). The APOE gene may not play a major role in the pathogenesis of major depression. The efficacy of venlafaxine is same as paroxetine after treatment for six weeks. The APOE (Ε2+Ε3) allele may be an indicator of the bad efficacy of paroxetine treatment.