A meta-analysis of the effects of
venlafaxine on anxiety associated with depression
Rudolph RL, Entsuah R, Chitra R
Wyeth-Ayerst Research,
Philadelphia, Pennsylvania 19101, USA.
J Clin Psychopharmacol 1998 Apr; 18(2):136-44
ABSTRACT
Venlafaxine is the first member of a novel class
of antidepressants that inhibits the reuptake of both serotonin and
norepinephrine. Clinical trials of venlafaxine have demonstrated its
efficacy and safety in the treatment of patients diagnosed with major
depression. Because patients who have depression also often have anxiety,
recent investigations have focused on determining whether venlafaxine can
relieve symptoms of anxiety in depressed patients. We performed a pooled
analysis of six short-term trials of venlafaxine, retrospectively measuring
anxiety in anxious depressed patients using the Hamilton Rating Scale for
Depression (HAM-D), Anxiety/Somatization factor and Anxiety Psychic item
scores. Three studies were placebo-controlled, and three were placebo- and
active-drug-controlled; active controls were imipramine in two trials and
trazodone in the third trial. Patients were categorized as having anxiety
accompanying depression if baseline HAM-D Anxiety Psychic item scores were 2
or greater. Anxious depressed patients treated with venlafaxine showed
greater improvement than those treated with placebo beginning at week 3,
according to the HAM-D Anxiety/Somatization factor score, and beginning at
week 1, according to the Anxiety Psychic item score. Both effects were
maintained at week 6 of treatment (and at week 12 in the one study of longer
duration). Finally, treatment with venlafaxine resulted in a highly
significant (p < or = 0.001) improvement in depression scores in patients
who were anxious at baseline, compared with placebo-treated patients. The
results of this analysis demonstrate that venlafaxine is more effective than
placebo in reducing symptoms of anxiety in depressed patients and suggest
that venlafaxine may afford a monotherapy option for treating patients who
have a comorbid diagnosis of depression with anxiety.
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