Moving from serotonin to serotonin-norepinephrine enhancement with increasing venlafaxine dose: clinical implications and strategies for a successful outcome in major depressive disorder

Fagiolini, Andrea; Cardoner, Narcis; Pirildar, Sebnem; Ittsakul, Pichai; Ng, Bernardo; Duailibi, Kalil; El Hindy, Nasser

doi:10.1080/14656566.2023.2242264

Cited by 6 publications

(7 citation statements)

References 56 publications

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“…Venlafaxine is known to improve prognosis and reduce residual symptoms in depression [27], and milnacipran is known for its bene ts in treating chronic pain [28]. Agomelatine is also widely used in adults, particularly for its ability to improve sleep parameters, such as reducing sleep latency and nocturnal awakenings [29].…”

Section: Discussionmentioning

confidence: 99%

A multicenter, retrospective study of the current status of antidepressant prescription use in outpatient settings in China

Zhao,

Chang,

et al. 2024

Preprint

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Background: Antidepressant prescribing has increased dramatically worldwide in recent years. Analyzing antidepressants in real-world settings can provide valuable data to support clinicians and health policymakers. Aim: This study used an extensive data set to examine the status and trends in antidepressant prescribing among the Chinese Han population from July 1, 2017, to June 30, 2022. Method: A retrospective study was conducted in three hospitals. Data were collected 2.5 years before and 2.5 years after the onset of the COVID-19 pandemic. We analyzed the number of patients diagnosed with depression and the corresponding antidepressant prescriptions. To explore the characteristics of antidepressant use across different ages and sexes, stratified analyses were performed using the chi-square test. Results: The study included 124,355 patients, and 400,840 antidepressant prescriptions were collected. Fluctuating upward trends were observed in the number of patients and antidepressant drugs. The three most frequently prescribed antidepressants were citalopram, escitalopram, and sertraline. Significant differences in antidepressant use were observed by sex and age. The number of patients after the COVID-19 pandemic increased by 37.1% compared to the pre-pandemic period, and the number of antidepressant prescriptions rose by 88.3%. Antidepressant monotherapy represented 76.6% of the prescriptions. The most common combination involved antidepressants and anxiolytics. Conclusion: Over the past five years, the number of patients and antidepressant prescriptions has shown upward trends. Citalopram, escitalopram, and sertraline are currently the leading antidepressants used in outpatient treatment of depressive disorders. The COVID-19 pandemic has significantly affected clinic visits and antidepressant prescriptions for patients with depression.

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Section: Discussionmentioning

confidence: 99%

A multicenter, retrospective study of the current status of antidepressant prescription use in outpatient settings in China

Zhao,

Chang,

et al. 2024

Preprint

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“…Therefore, venlafaxine may have an effect on symptoms mediated by norepinephrine and dopamine, such as anhedonia, amotivation, and low energy 23 24 , 37 - 39 However, there is limited information about the effect of venlafaxine on motivational deficits.…”

Section: Introductionmentioning

confidence: 99%

Effect of venlafaxine on anhedonia and amotivation in patients with major depressive disorder

McIntyre,

Agid,

Biesheuvel

et al. 2024

CNS Spectr.

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Objective Serotonin norepinephrine reuptake inhibitors (SNRIs) have been postulated to afford benefits in alleviating anhedonia and amotivation. This post hoc pooled analysis evaluated the effect of venlafaxine XR, an SNRI, on these symptoms in patients with major depressive disorder (MDD). Methods Data was pooled from five short-term randomized, placebo-controlled studies of venlafaxine XR for the treatment of MDD, comprising 1087 (venlafaxine XR, n = 585; placebo, n = 502) adult subjects. The change from baseline score in the MADRS anhedonia factor (based on items 1 [apparent sadness], 2 [reported sadness], 6 [concentration difficulties], 7 [lassitude], and 8 [inability to feel]) for anhedonia, and in motivational deficits (based on 3 items of HAM-D17: involvement in work and activities, psychomotor retardation, and energy level [ie, general somatic symptoms]) for amotivation, were measured through 8 weeks. Mixed model repeated measures (MMRMs) were used to analyze changes over time and ANCOVA to analyze the change from baseline at week 8 with LOCF employed to handle missing data. Results At the end of 8 weeks, the change from baseline was significantly greater in patients on venlafaxine XR in both anhedonia (mean, 95% CI: −2.73 [−3.63, −1.82], p < 0.0001) and amotivation scores (mean, 95% CI: −0.78 [−1.04, −0.52], p < 0.0001) than those on placebo. For both measures, the between-group separation from baseline was statistically significant starting from week 2 onwards, and it increased over time. Conclusion This analysis demonstrates that venlafaxine XR is effective in improving symptoms of anhedonia and motivational deficits in patients with MDD.

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“… 5 However, even after receiving antidepressant therapy or psychotherapy, many individuals with depression continue to experience residual symptoms, which often include fatigue, loss of interest and low energy, together with anxiety, and which prevent complete functional recovery. 6 Furthermore, patients with (rather than without) residual symptoms after treatment of an MDD episode are more likely to experience relapse of depression. 6 Therefore, in some settings, it is recommended to continue antidepressant maintenance therapy for ≥2 years in patients with marked residual symptoms, thus again underscoring the pivotal monitoring responsibility that PCPs have in the management of patients with residual symptoms.…”

Section: Introductionmentioning

confidence: 99%

“… 6 Furthermore, patients with (rather than without) residual symptoms after treatment of an MDD episode are more likely to experience relapse of depression. 6 Therefore, in some settings, it is recommended to continue antidepressant maintenance therapy for ≥2 years in patients with marked residual symptoms, thus again underscoring the pivotal monitoring responsibility that PCPs have in the management of patients with residual symptoms. 4 …”

Section: Introductionmentioning

confidence: 99%

“…During antidepressant pharmacotherapy for patients with MDD, including patients in remission, varied residual symptoms (eg, amotivation, anergia, anhedonia, anxiety, emotional blunting, fatigue, guilt, insomnia, loss of interest, pain, pessimism, reduced cognitive function, reduced libido, weight gain, and work impairment) may occur. 5 , 6 , 10 , 19–23 Indeed, residual symptoms are frequent, and recent cross-sectional studies suggest that these symptoms affect approximately 45–75% of patients with depression, with marked interindividual variability. 5 , 6 , 24 , 25 One multicentre, cross-sectional study evaluated the association of residual symptoms with social functional impairment in 1503 patients with depression who had recovered by ≥50% (by visual analogue-scale evaluation) after antidepressant pharmacotherapy for 8–12 weeks.…”

Section: Introductionmentioning

confidence: 99%

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Improving Mental Health Outcomes in Patients with Major Depressive Disorder in the Gulf States: A Review of the Role of Electronic Enablers in Monitoring Residual Symptoms

Ahmed,

Reagu,

Alkhoori

et al. 2024

JMDH

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Moving from serotonin to serotonin-norepinephrine enhancement with increasing venlafaxine dose: clinical implications and strategies for a successful outcome in major depressive disorder

Cited by 6 publications

References 56 publications

A multicenter, retrospective study of the current status of antidepressant prescription use in outpatient settings in China

A multicenter, retrospective study of the current status of antidepressant prescription use in outpatient settings in China

Effect of venlafaxine on anhedonia and amotivation in patients with major depressive disorder

Improving Mental Health Outcomes in Patients with Major Depressive Disorder in the Gulf States: A Review of the Role of Electronic Enablers in Monitoring Residual Symptoms

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