Posted by SLS on September 17, 2012, at 16:51:53
In reply to Re: Pristiq dosages of 200 - 400 mg/day. » SLS, posted by phidippus on September 17, 2012, at 15:56:22
> >paroxetine will get more people well than any >other SSRI. Lexapro comes close
>
> Actually, a recent study showed Zoloft and Lexapro to be most efficacious.
>
> http://www.healthyplace.com/lexapro/patient-center/lexapro-zoloft-best-of-newer-antidepressants/
>
> http://www.washingtonpost.com/wp-dyn/content/article/2009/01/29/AR2009012901774.html
>
> http://depressionintrospection.wordpress.com/2009/02/16/antidepressant-rankings-zoloft-and-lexapro-considered-best-overall/ - this one places Remeron first.
>
> Eric
I don't buy it. I question the methods of this study."The Italian researchers reviewed 117 studies that included more than 25,000 patients with major depression to come to this conclusion."
What dosages were used? This is the part that is often ignored when comparing drugs. 100 - 200 mg of Zoloft will always be more effective than 75 - 150 mg of Effexor. This type of bias in the dosages used occurs all the time. The study you refer to was a retrospective analysis, and not a prospective investigation. The dosages used were likely not controlled for through a selection process of 25,000 patients. We would need to see the study itself as it was published in The Lancet in 2009.
The study said that venlafaxine was as efficacious as Zoloft and Lexapro, but that it was not tolerated as well. I would agree that venlafaxine is generally not as tolerable, but I still believe that it is more efficacious than SSRIs. Escitalopram comes pretty close, though.
Maybe the actual 2009 study can be located?
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Same year 2009: What do you think?
http://www.ncbi.nlm.nih.gov/pubmed/19165525Eur Arch Psychiatry Clin Neurosci. 2009 Apr;259(3):172-85. Epub 2009 Jan 22.
The effect of venlafaxine compared with other antidepressants and placebo in the treatment of major depression: a meta-analysis.
Bauer M, Tharmanathan P, Volz HP, Moeller HJ, Freemantle N.
SourceDepartment of Psychiatriy and Psychotherapy, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstr. 74, Dresden 01307, Germany.
AbstractOBJECTIVE:
Meta-analysis of all available trials of Venlafaxine in the treatment of major depressive disorders, including treatment resistant depression and long-term relapse prevention.
METHODS:
We conducted a meta-analysis comparing venlafaxine and tricyclics, or selective serotonin reuptake inhibitors (SSRIs), in major depression. We also included trials comparing venlafaxine and alternative antidepressants in subjects with treatment resistant depression, or compared with placebo in long-term relapse prevention. Trials were identified through searches of Medline, Embase, Cochrane Library and through accessing unpublished trials held by the manufacturer. Results based on intention to treat analyses where available, were pooled using theoretically exact conditional maximum likelihood methods for fixed effects (primary analyses), and numerical simulation using a Gibbs sampler for full random effects.
RESULTS:
Compared to all SSRIs for the treatment of major depression (fluoxetine, paroxetine, sertraline, citalopram, escitalopram and fluvoxamine), venlafaxine was associated with a greater response [odds ratio 1.15 (95% CI 1.02-1.29)] and remission [odds ratio 1.19 (95% CI 1.06-1.34)]. Overall drop out rates appeared similar for SSRIs and venlafaxine. Compared to tricyclics, response to venlafaxine was estimated to be greater by exact method, odds ratio 1.21 (95% CI 1.03-1.43), but not statistically significantly different, using a full random effects method odds ratio 1.22 (95% CI 0.96-1.54). We observed no difference in remission rates (odds ratio 1.06 (95% CI 0.74-1.63)). Tricyclics were less well tolerated with higher overall drop out rates. Compared to alternative antidepressants in treatment resistant depression (trials included comparison with sertraline, bupropion, fluoxetine, citalopram, and one with a range of agents-mostly SSRIs), the odds ratio for response was 1.35 (95% CI 1.19-1.54). The odds ratio for remission was 1.35 (95% CI 1.20-1.52). Compared to placebo the odds ratio for relapse prevention with venlafaxine was 0.37 (95% CI 0.27-0.51).
CONCLUSION:
This meta analysis provides evidence of the clinical efficacy of venlafaxine in achieving therapeutic response and remission in patients with major depression. Venlafaxine appears more effective than SSRIs, and at least as effective as tricyclic antidepressants, in the treatment of major depressive episode. Venlafaxine appeared more effective than comparators in treatment resistant depression. In addition, venlafaxine effective in reducing relapse when given long term after major depressive episode.
PMID:
19165525
[PubMed - indexed for MEDLINE]-------------------------------------------------------
- ScottSome see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1024121
URL: http://www.dr-bob.org/babble/20120912/msgs/1025918.html