||Background: The comparative efficacy of selective serotonin reuptake inhibitors (SSRIs)
and serotonin-norepinephrine reuptake inhibitors (SNRIs) was recently debated. Meta-analyses,
based mainly on fluoxetine comparator data, suggest that the SNRI venlafaxine has
superior efficacy to SSRIs in treatment of major depression. Objective: To compare
quality of life (QOL), efficacy, safety, and tolerability associated with sertraline
and venlafaxine extended release (XR) for treatment of DSM-IV major depression. Method:
This was an 8-week, double-blind, randomized study of sertraline (50-150 mg/day) versus
venlafaxine XR (75-225 mg/day), followed by a 2-week taper period. Subjects were recruited
from 7 sites in Turkey and 6 sites in Australia between October 2002 and July 2003.
The primary outcome measure was the Quality of Life Enjoyment and Satisfaction Questionnaire.
Secondary outcome measures included measures of depression (including response and
remission), anxiety, pain, safety (e.g., blood pressure), and tolerability (e.g.,
discontinuation symptoms). Results: A total of 163 subjects received study treatment
(women, 69%; mean age, 37.0 [SD = 12.9] years). No significant differences in QOL
or efficacy were noted between treatments on the primary or secondary endpoints for
the total study population or the anxious depression and severe depression subgroups.
A priori analyses of symptoms associated with treatment discontinuation demonstrated
no difference between treatment groups. However, in post hoc analyses, sertraline
was associated with less burden of moderate to severe discontinuation symptoms. Venlafaxine
XR was associated with a relative increase in mean blood pressure (supine diastolic
blood pressure, -4.4 mm Hg difference at week 8/last observation carried forward).
Conclusion: Sertraline and venlafaxine XR demonstrated comparable effects on QOL and
efficacy in treatment of major depression, although sertraline may be associated with
a lower symptom burden during treatment discontinuation and a reduced risk of blood