venlafaxine (Effexor)
[Pharma-Clinics. The drug of the month. Venlafaxine (Efexor)]

[Article in French]

Ansseau M.

Universite de Liege, Service de Psychiatrie et de Psychologie medicale.

Venlafaxine (Efexor) is the first representative of a new class of antidepressants: serotonin noradrenaline reuptake inhibitors. Its usual dose is 75 mg/d in two intakes but can be progressively increased until a maximal daily dose of 375 mg/d in severe or resistant depression, particularly among inpatients. The efficacy of venlafaxine is at least equivalent to reference antidepressants. At high doses, venlafaxine could even exhibit a better efficacy and a shorter latency than current compounds. Its profile of side-effects is quite similar to selective serotonin reuptake inhibitors with mainly nausea, with the exception if an increase in blood pressure which can appear at high doses. In total, venlafaxine represents an interesting innovation in the pharmacological treatment of depression.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9564231&dopt=Abstract venlafaxine Effexor refs
Effexor, Effexor XR

venlafaxine (Effexor)
Antidepressant efficacy and cardiovascular safety of venlafaxine in young vs old patients with comorbid medical disorders.

Zimmer B, Kant R, Zeiler D, Brilmyer M.

Allegheny General Hospital, Department of Psychiatry, Pittsburgh, PA 15212-5234, USA.

OBJECTIVE: To determine whether venlafaxine exerts a differential effect on blood pressure in young versus old depressed patients. METHOD: We compared thirty-four consecutive patients treated with 50-250 mg/day venlafaxine for major depressive disorder or another major mood disorder at our medical college's ambulatory neuropsychiatry program. We obtained baseline and follow-up blood pressure measurements. Each patient also received a baseline and final Clinical Global Impressions (CGI) score; global improvement was determined by consensus of two clinicians. RESULTS: Sixteen nongeriatric patients (age, 13 to 56 years) were compared with eighteen elderly patients (age, 65 to 86 years). Most patients (88%) had serious medical comorbidities or histories. Despite a higher mean daily venlafaxine dosage for patients in the young group, no significant changes in systolic blood pressure were noted in either group. For the older group, we found a non-statistically significant 4.7 mm Hg mean increase in diastolic blood pressure. No patient became hypertensive. We also found a negative correlation between baseline diastolic blood pressure and change in diastolic blood pressure during treatment with venlafaxine. This inverse relationship was statistically significant in the older patients. CONCLUSIONS: Venlafaxine was not associated with significant, sustained changes in blood pressure in any patient receiving dosages of 50-250 mg/day. Minimal changes in diastolic blood pressure were no more likely to occur in older venlafaxine-treated patients than in younger ones. Higher baseline diastolic blood pressure in older patients, but not in younger ones, seemed to protect against diastolic adrenergic blood pressure effects of venlafaxine.

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Effexor, Effexor XR

venlafaxine (Effexor)
[Pattern of usage of new antidepressants in clinical practice]

[Article in Spanish]

Montejo AL, Gilaberte I, Fombellida C, Hylan TR, Sacristan JA.

Centro de Salud La Alamedilla, Hospital Clinico Universitario de Salamanca.

INTRODUCTION: Data from naturalistic studies have reported differences in the clinical use of antidepressants referring to the need for adjusting doses, treatment duration, tolerability and use of concomitant medication. These differences could be considered as an indicator of the effectiveness of antidepressants in clinical practice settings. OBJECTIVES: It is a naturalistic, retrospective, observational study which objective is to evaluate and compare the pattern of antidepressant use (fluoxetine, fluvoxamine, paroxetine, sertraline, venlafaxine) and to establish if there is a relation between the different pattern of use and the effectiveness of them. DATA AND METHODS: A retrospective dataset of patients who initiated therapy on fluoxetine, fluvoxamine, paroxetine, sertraline, or venlafaxine with a follow-up period of 6 months was used. Information about clinical characteristics of patients and antidepressant pattern of use were collected. Pattern of antidepressant use were defined as: "initial doses", "upward dose titration", "augmentation strategy", "switching" and "early interruption of treatment". The efficacy of the therapy was assessed by the CGI-improvement. RESULTS: Fluoxetine was the antidepressant more associated with a statistical significance (p = 0.001) to an stable pattern of use (initial doses without upward dose titration, switching or augmentation). After controlling for other observed baseline characteristics, patients who remained on their initial antidepressant therapy, with a stable pattern of use were 1.61 times more likely than patients who had an adjustment to therapy to experience a treatment response. Patients who initiated treatment with sertraline or venlafaxine were 2.155 and 4.831 times less likely, respectively, to experience a response relative to patients who initiated therapy on fluoxetine. CONCLUSIONS: The need to upward dose titration, switching or augmentation in the treatment could be indicated a worse therapeutic control of the symptoms. Patients treated with fluoxetine are in a stable pattern of use more likely than patients in the other antidepressants, this fact is related with better global therapeutic results.

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Effexor, Effexor XR

venlafaxine (Effexor)
The effect of venlafaxine treatment on the behavioural and neurochemical changes in the olfactory bulbectomised rat.

McGrath C, Norman TR.

Department of Psychiatry, Austin & Repatriation Medical Centre, Heidelberg, Victoria, Australia. C.mcgrath medicine.unimelb.edu.au

In the present study, the effect of chronic treatment with venlafaxine on beta1 and 5-HT2 receptor populations was examined in the frontal cortex of olfactory bulbectomised (OB) and sham operated (SO) animals. The effect of these drugs on the behaviour of the animals on the elevated plus maze and the "open field" was also assessed. Removal of the bulbs resulted in a characteristic increase in locomotor activity in the OB animals in the "open field" which was reversed by chronic venlafaxine treatment. Venlafaxine produced a slight reduction in the number of open arm entries made by the OB animals although this failed to reach significance. Maximum change in temperature from baseline, following a single dose of 8-OH-DPAT (1.5 mg kg(-1) SC), was used to assess the function of the 5-HT1A receptors. Chronic venlafaxine treatment had no effect on the hypothermic response to 8-OH-DPAT in the present study. A decrease in the affinity of beta1-adrenoceptors was found following olfactory bulbectomy and this was normalised by treatment with venlafaxine. No bulbectomy-induced changes were evident 32 days post surgery in beta1-adrenoceptor density; however, chronic treatment with venlafaxine significantly reduced the density of these receptors in the OB animals. Olfactory bulbectomy did not produce any changes in 5-HT2 receptor populations but venlafaxine administration significantly reduced the density of these receptors in both SO and OB animals. The findings of the present study further validate the usefulness of the OB as an animal model, for the detection of antidepressants from a wide variety of classes.

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Effexor, Effexor XR

venlafaxine (Effexor)
Use of bupropion with SRIs and venlafaxine.

Spier SA.

University of Maryland School of Medicine, Baltimore 21202-2165, USA.

Because of reported efficacy of combining classes of antidepressants, 25 patients were treated with bupropion in combination with SRI's and venlafaxine. Fifteen patients inadequately responsive to monotherapy received combination treatment; ten patients without residual symptoms received adjunctive bupropion to treat SRI- or venlafaxine-induced side effects. Fourteen subjects (56%) responded, 11 (44%) did not. Twelve of 15 subjects receiving combination treatment to boost the effects of monotherapy responded, while only 2 of 10 subjects receiving combination treatment for side effects responded. Combination therapy was well tolerated even by geriatric and "medically frail" patients.

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Effexor, Effexor XR