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Re-evaluation of the efficacy and tolerability of venlafaxine vs SSRI: meta-analysis

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Abstract

Rationale

A number of reviews have claimed that the selective serotonin and noradrenalin re-uptake inhibitor venlafaxine is more effective than selective serotonin re-uptake inhibitors (SSRIs) in achieving remission and symptom reduction in major depression.

Objectives

The aim of this study was to systematically review studies on the efficacy of venlafaxine vs SSRI and to evaluate the influence of methodological issues on the effect sizes.

Materials and methods

Following a systematic literature search, we pooled data on depression scores, response, remission and dropout rates. We also performed sub-group analyses.

Results

Seventeen studies were included. We found no significant superiority in remission rates (risk ratio [RR] = 1.07, 95% confidence intervals [95%CI] = 0.99 to 1.15, numbers needed to treat [NNT] = 34) and a small superiority in response rates (RR = 1.06, 95%CI = 1.01 to 1.12, NNT = 27) over SSRIs. There was a small advantage to venlafaxine in change scores (effect size = −0.09, 95%CI = −0.16 to −0.02, p = 0.013), which did not reach significance when post-treatment scores were used (effect size = −0.06, 95%CI = −0.13 to 0.00). Discontinuation rates due to adverse events were 45% higher in the venlafaxine group. The main reasons for the differences between this analysis and previous reviews were the exclusion of studies with methodological limitations, avoiding to pool selectively reported study results and exclusion of studies available as abstracts only.

Conclusions

Our analysis does not support a clinically significant superiority of venlafaxine over SSRIs. Differences between our study and previous reviews were not accounted for by technical aspects of data synthesis, but rather by study selection and choice of outcome parameters.

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Acknowledgements

All authors have been involved in a health technology assessment (HTA) project on the efficacy of selective serotonin and noradrenalin re-uptake inhibitors in major depression, which was funded by the German Institute for Quality and Efficiency in Health Care (IQWiG). However, apart from the literature search, this paper is entirely independent of the HTA project and based solely on published data. It may differ in its methods and conclusions and has therefore neither prejudicial quality nor does it anticipate any results of the HTA report. The paper does not necessarily reflect the opinion of the IQWiG.

The present study received no further external funding.

We thank two anonymous reviewers for valuable comments.

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Authors and Affiliations

  1. University of Ulm, Ulm, Germany

    S. Weinmann, T. Becker & M. Koesters

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  1. S. Weinmann
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Correspondence to S. Weinmann.

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Weinmann, S., Becker, T. & Koesters, M. Re-evaluation of the efficacy and tolerability of venlafaxine vs SSRI: meta-analysis. Psychopharmacology 196, 511–520 (2008). https://doi.org/10.1007/s00213-007-0975-9

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  • DOI: https://doi.org/10.1007/s00213-007-0975-9

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