Double-blind comparison of venlafaxine and amitriptyline in outpatients with major depression with or without melancholia

Abstract

The purpose of this study was to compare the efficacy and tolerability of venlafaxine and amitriptyline in outpatients with major depression with or without melancholia. This was an 8-week, multicentre, randomized, double-blind, parallel-group comparison of venlafaxine and amitriptyline. Outpatients with DSM-IV major depression, a minimum score of 20 on the 21-item Hamilton Depression Rating Scale (HAM-D), and depressive symptoms for at least 1 month were eligible. Patients were randomly assigned to venlafaxine or amitriptyline, both drugs titrated to a maximum of 150 mg/day until study day 15. The primary efficacy variables were the final on-therapy scores on the HAM-D, Montgomery-Asberg Depression Rating Scale and Clinical Global Impression severity scales. Data were evaluated on an intent-to-treat basis using the LOCF method. One hundred and 16 patients were randomized, and 115 were evaluated for efficacy. Both drugs showed efficacy in the treatment of depression with or without melancholia. No significant differences were noted between treatments for any efficacy parameter. However, significantly (p < 0.05) more patients in the amitriptyline group had at least one adverse event. These results should support the efficacy and tolerability of venlafaxine in comparison with amitriptyline for treating major depression with or without melancholia.

Depression in patients with Parkinson's disease: Impact on functioning

“…Perhaps this lack of statistical significance was due to the small size of our sample of depressive patients for this kind of analysis [19]. However, there was a tendency to increased scores in PD scales and MADRS in those patients that were above H&Y staging 3 when compared to patients in moderate stages (that is, lower than 3).…”

“…Clinical diagnosis of depression was made according to the ICD-10 research diagnostic criteria [16] if patient had five or more of the following symptoms during at least 2 weeks before the clinical evaluation, being the depressed mood or loss of interest or pleasure at least one of the symptoms: depressed mood, reduced interest or pleasure, decrease or increase in appetite and/or weight, insomnia or hypersomnia, psychomotor agitation or retardation, loss of energy, feelings of worthlessness or guilt, poor concentration, and suicidal ideation. The depression severity was measured through the Montgomery-Asberg Depression Rating Scale-MADRS [17], which congregates these criteria and that is widely used in psychiatric health units in Brazil [18][19][20][21]. A score equal or superior than 7 indicates clinically relevant depressive symptoms, while Silberman et al [18] found that scores above 10 suggest depressive disorder in PD patients.…”

Estudos latino-americanos sobre melancolia: um transtorno do humor melhor definido para o CID-11

“…6,7 In the section concerning mood and affective disorders of the [6][7][8][9][10][11][13][14][15]18 (see Table 2 26 Calil, in a non-systematic review, examined the Latin American concept of depression and presented a Brazilian proposal. 27 27,28 Banzato, in a non-systematic review, investigated classification issues in psychiatry: the move towards the ICD-11 and DSM-V. 29 The 30 10,36 In the 1990s, however, several studies found that the sensitivity of the DST for the diagnosis of the melancholic subtype of major depression as defined by the DSM-III was low (35-45%), although its specificity was high (70-89%). 10,16 In a prospective study, Dratcu …”

Evaluating the relationship of high-dose venlafaxine prescribing to treatment-resistant depression

“…Comparative studies against amitriptyline (Gentil et al, 2000) report no difference in efficacy in treating depressive symptoms, whereas comparisons with imipramine (Shrivastava et al, 1994) and fluoxetine (Clerc et al, 1994) have suggested venlafaxine to be significantly superior in certain populations. Dierick et al (1996) reported venlafaxine at 75 mg daily to be comparable to fluoxetine, but at 150 mg daily it was shown to be superior to fluoxetine in treating out-patients with major depression.…”