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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Major depression is a debilitating disorder that is often undertreated. Psychotherapy, electroconvulsive therapy, and pharmacotherapy are options for management. Tricyclic antidepressants and selective serotonin reuptake inhibitors are the cornerstones of drug therapy. Venlafaxine, a phenylethylamine antidepressant that primarily inhibits reuptake of norepinephrine and serotonin, is an alternative to those agents. It has been studied in short-term and continuation studies and appears to have efficacy similar to that of imipramine, trazodone, and fluoxetine. Moreover, venlafaxine is effective in approximately one-third of patients with treatment-resistant depression. Venlafaxine is metabolized by the P-450 enzyme system to an active metabolite O-desmethyl-venlafaxine, which is excreted renally. Nausea, somnolence, and dizziness are dose-related adverse effects that often occur with initiation of therapy. Increases in blood pressure, particularly with high dosages, also may occur. Drug-drug interactions appear to be minimal.
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PMID:Therapeutic options for treating major depression, and the role of venlafaxine. 872 93

The economic burden of depression is often underestimated, especially when both the direct and indirect costs of treating the disease are considered. The costs associated with antidepressant drug therapy are often the focus of efforts to reduce overall treatment costs, but in actuality they represent only 10% of the overall economic costs of depression. Thus, in analyses of the costs of depression, other factors-including hospitalization, physician costs, monitoring, and indirect costs associated with lost productivity and comorbidity-are important. Economic assessments comparing different antidepressant classes have often found that newer antidepressants are more cost-effective than older, less expensive drugs because of improved tolerability or efficacy. Venlafaxine represents the newest class of antidepressants and offers potential pharmacologic benefits, including early onset of action, dose flexibility, broad range of activity, and improved tolerance. In one analysis that used the results from a study of 67 hospitalized depressed patients, venlafaxine was estimated to result in a cost savings of 11.3% versus fluoxetine. These findings support the concept that the overall costs of depression are more important than the drug costs in determining the cost-effectiveness of therapy.
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PMID:Cost-effectiveness of venlafaxine for the treatment of major depression in hospitalized patients. 873 94

Venlafaxine is a phenethylamine derivative that has recently been approved for use in the treatment of depression. It is chemically unrelated to tricyclic, tetracyclic, or other available antidepressant agents. Anticholinergic, hypotensive, hypertensive, and cardiotoxic side effects are rare. Two fatal cases encountered at separate laboratories are discussed, both involve high levels of venlafaxine. Concentrations of the drug in peripheral blood, heart blood, urine, vitreous humor, and liver are reported. Descriptions of extraction and gas chromatographic methods for confirmation and quantitation are included.
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PMID:Two fatal cases of venlafaxine poisoning. 883 66

The effectiveness of the novel antidepressant venlafaxine was assessed in various subpopulations of depressed patients. Data from six comparable placebo-controlled, double-blind studies were pooled and analyzed (venlafaxine, n = 930; placebo, n = 500). Outcome variables were the Hamilton Rating Scale for Depression total score, Montgomery-Asberg Depression Rating Scale total score, and Clinical Global Impressions severity scores. Venlafaxine had notable antidepressant results in depressed patients regardless of age (although no age differences were apparent, too few patients over age 65 had been enrolled in the six studies to permit definitive conclusions), gender, presence of melancholia, and severity or duration of depression. Our analysis indicates that venlafaxine treatment is effective in a broad range of depressed patients.
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PMID:Effectiveness of venlafaxine treatment in a broad spectrum of depressed patients: a meta-analysis. 885 50

Social phobia is a prevalent anxiety disorder with potentially significant dysfunction and a high rate of comorbid depression. Treatment with an antidepressant is often indicated. Venlafaxine's dual activity at both serotonin and norepinephrine transporters suggests that it might be efficacious in treating social phobia, particularly in patients who do not respond to selective serotonin reuptake inhibitors (SSRIs). This report describes an open-label trial of venlafaxine in 9 patients with social phobia. Eight patients had previously been treated with an SSRI and had either been unable to tolerate the medication or failed to respond to it. Eight patients had a marked improvement on venlafaxine. The results from this chart review suggest that venlafaxine may be a valuable treatment for social phobia. Clearly, larger double-blind placebo-controlled studies are needed. Patients with social phobia may do better with a starting dose smaller than the one in the package insert.
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PMID:Venlafaxine in social phobia. 885 51

Excessive stimulation of serotonin 5HT1A receptors causes a syndrome of serotonin excess that consists of shivering, muscle rigidity, salivation, confusion, agitation and hyperthermia. The most common cause of this syndrome is an interaction between a monoamine oxidase inhibitor (MAOI) and a specific serotonin reuptake inhibitor. Venlafaxine is a new antidepressant agent that inhibits the reuptake of serotonin and norepinephrine. We report a venlafaxine-MAOI interaction that resulted in the serotonin syndrome in a 23-y-old male who was taking tranylcypromine for depression. He had been well until the morning of presentation when he took 1/2 tab of venlafaxine. Within 2 h he became confused with jerking movements of his extremities, tremors and rigidity. He was brought directly to a hospital where he was found to be agitated and confused with shivering, myoclonic jerks, rigidity, salivation and diaphoresis. His pupils were 7 mm and sluggishly reactive to light. Vital signs were: blood pressure 120/67 mm Hg, heart rate 127/min, respiratory rate 28/min, and temperature 97 F. After 180 mg of diazepam i.v. he remained tremulous with muscle rigidity and clenched jaws. He was intubated for airway protection and because of hypoventilation, and was paralyzed to control muscle rigidity. His subsequent course was remarkable for non-immune thrombocytopenia which resolved. The patient's maximal temperature was 101.2 F and his CPK remained < 500 units/L with no other evidence of rhabdomyolysis. His mental status normalized and he was transferred to a psychiatry ward. This patient survived without sequelae due to the aggressive sedation and neuromuscular paralysis.
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PMID:Serotonin syndrome from venlafaxine-tranylcypromine interaction. 888 41

This open-label, multicenter study of depressed men and women > or = 65 years old was conducted at 18 European hospitals to evaluate the safety, efficacy, and clinical acceptability of venlafaxine in elderly depressed patients during 1 year. Patients received venlafaxine orally as 25-mg tablets two or three times daily for up to 12 months, Dosages were titrated upward during the first 15 days and then maintained between 50 and 150 mg/day. Safety was assessed on the basis of study events, vital signs, electrocardiograms tracings, and laboratory determinations. Efficacy was assessed using the Montgomery-Asberg Depression Rating Scale (MADRS), the Clinical Global Impressions (CGI) scale, and the Hospital Anxiety and Depression scale. Patients' subjective ratings of the drug's tolerability and efficacy were collected. Study events were reported by 62% of patients. Few clinically or statistically significant changes occurred in vital signs or electrocardiogram or laboratory findings. No serious study events, including three deaths, were considered unexpected given the nature of the population and the length of treatment. Most patients (81%) believed they had no side effects. Clinical response was achieved in 67% of patients by month 2 (as measured by improvement on the CGI) and by 64% of patients by month 3 (as measured by improvement on the MADRS), suggesting that venlafaxine demonstrates antidepressant efficacy. Eighty-five (73%) patients were still in the study after 6 months and 77 (66%) were still participating at 12 months. Overall, most patients (80%) felt much or very much improved at the end of the study. Venlafaxine was safe, effective, and clinically acceptable treatment for depression in elderly patients.
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PMID:An open-label evaluation of the long-term safety of oral venlafaxine in depressed elderly patients. 889 35

Venlafaxine, a member of a novel chemical class, phenethylamines, is a new antidepressant that inhibits neuronal uptake of serotonin, norepinephrine, and dopamine (in decreasing order of potency) at doses of 75 to 375 mg per day. Depression and antidepressant drugs are known to modify human sleep patterns. Our objective in this double-blind, placebo-controlled study was to assess the effects of venlafaxine on polysomnographic variables by comparing the effects of venlafaxine and placebo on sleep (hypnographic and all-night electroencephalographic [EEG] spectral analysis) and clinical measures (Hamilton Rating Scale for Depression [HAM-D], Montgomery-Asberg Depression Rating Scale [MADRS], and Clinical Global Impressions [CGI]) in inpatients with major depression (DSM-III-R). Following a 7- to 13-day placebo washout period, patients were randomly assigned to receive either placebo or venlafaxine (maximum dose 225 mg/day) for up to 29 days. Sleep evaluations took place at baseline (3 nights immediately before entering the double-blind phase), after 1 week of treatment, and after 1 month of treatment. Sleep stage parameters and all-night spectral parameters were first tested by analysis of variance for repeated measures and then, if indicated, by two-tailed Student t-test. The results on psychiatric rating scales showed improvement from baseline in both treatment groups at all time points, with improvement tending to be greater in the venlafaxine group. Venlafaxine induced a decrease of sleep continuity (decreased total sleep time and increased wake time), an important increase in the onset latency of rapid eye movement (REM) sleep, and a decrease in total REM sleep duration. All-night sleep EEG frequency structure was not modified significantly by venlafaxine treatment as compared with placebo. In conclusion, venlafaxine, despite its novel chemical structure, shows a sleep profile comparable with that of most classical antidepressants.
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PMID:A double-blind, placebo-controlled evaluation of the effects of orally administered venlafaxine on sleep in inpatients with major depression. 899 85

Venlafaxine has demonstrated efficacy for depression, and recent reports and clinical experience suggest that it may be effective for the treatment of anxiety disorders as well. We present what we believe are the first data from a controlled study designed to test the efficacy of venlafaxine for the treatment of panic disorder. There were 25 patients enrolled at one site of a five-center study; 13 received venlafaxine and 12 received placebo. There were more dropouts for placebo than for venlafaxine (8/12 vs. 2/13) in this 8-week acute trial. Patients treated with venlafaxine experienced significantly greater global improvement than those on placebo and exhibited trends toward greater improvement on anxiety and depression symptoms as assessed by the Hamilton rating scales. These data encourage further evaluation of venlafaxine for the treatment of panic disorder.
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PMID:Venlafaxine for panic disorder: results from a double-blind, placebo-controlled study. 899 89

New drugs are being developed for the management of depression in response to the growing awareness of the prevalence and disability associated with the disorder and the need for agents with improved side effect profiles. All antidepressants are equally effective for treating uncomplicated unipolar depression without psychotic features. For patients with atypical depression with prominent anxiety, agitation, sleep loss, and irritability, monoamine oxidase inhibitors are the first choice. Data are accumulating supporting the efficacy of selective serotonin reuptake inhibitors (SSRIs) in these depressive subtypes. Factors to consider when choosing an antidepressant include spectrum of adverse effects, long-term tolerability, dosing schedule, clinically significant drug interactions, underlying medical conditions, earlier response to therapy, and pharmacoeconomics. Based on these criteria, it is suggested that a trial with the SSRIs be attempted first. Venlafaxine and nefazodone are newer agents with mechanisms of action that have advantages over tricyclic antidepressants and monoamine oxidase inhibitors. Choosing a drug that is effective, tolerable, and convenient will improve the likelihood of achieving and maintaining a full remission. It will also decrease the morbidity and mortality of this very treatable disease.
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PMID:Rational drug use in the treatment of depression. 901 65


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