Yvonne-B. Schueler and Markus Koesters contributed equally to this publication.
A systematic review of duloxetine and venlafaxine in major depression, including unpublished data
Article first published online: 10 SEP 2010
© 2010 John Wiley & Sons A/S
Acta Psychiatrica Scandinavica
Volume 123, Issue 4, pages 247–265, April 2011
How to Cite
Schueler, Y.-B., Koesters, M., Wieseler, B., Grouven, U., Kromp, M., Kerekes, M. F., Kreis, J., Kaiser, T., Becker, T. and Weinmann, S. (2011), A systematic review of duloxetine and venlafaxine in major depression, including unpublished data. Acta Psychiatrica Scandinavica, 123: 247–265. doi: 10.1111/j.1600-0447.2010.01599.x
- Issue published online: 6 MAR 2011
- Article first published online: 10 SEP 2010
- Accepted for publication August 11, 2010
- selective serotonin and norepinephrine reuptake inhibitors;
- systematic review;
Schueler Y-B, Koesters M, Wieseler B, Grouven U, Kromp M, Kerekes MF, Kreis J, Kaiser T, Becker T, Weinmann S. A systematic review of duloxetine and venlafaxine in major depression, including unpublished data.
Objective: To determine the short-term antidepressant efficacy and tolerability of duloxetine and venlafaxine vs. each other, placebo, selective serotonin reuptake inhibitors (SSRIs), and tri- and tetracyclic antidepressants (TCAs) in adults with major depression.
Method: Meta-analysis of randomised controlled trials identified through bibliographical databases and other sources, including unpublished manufacturer reports.
Results: Fifty-four studies including venlafaxine arms (n = 12 816), 14 including duloxetine arms (n = 4528), and two direct comparisons (n = 836) were analysed. Twenty-three studies were previously unpublished. In the meta-analysis, both duloxetine and venlafaxine showed superior efficacy (higher remission and response rates) and inferior tolerability (higher discontinuation rates due to adverse events) to placebo. Venlafaxine had superior efficacy in response rates but inferior tolerability to SSRIs (OR = 1.20, 95% CI 1.07–1.35 and 1.38, 95% CI 1.15–1.66, respectively), and no differences in efficacy and tolerability to TCAs. Duloxetine did not show any advantages over other antidepressants and was less well tolerated than SSRIs and venlafaxine (OR = 1.53, 95% CI 1.10–2.13 and OR 1.79, 95% CI 1.16–2.78, respectively).
Conclusion: Rather than being a first-line option, venlafaxine appears to be a valid alternative in patients who do not tolerate or respond to SSRIs or TCAs. Duloxetine does not seem to be indicated as a first-line treatment.