Venlafaxine Extended Release in Posttraumatic Stress Disorder

Abstract

This 12-week, double-blind, multicenter trial evaluated the efficacy of venlafaxine extended release (ER), sertraline, and placebo in adult outpatients (N = 538) with a primary diagnosis of posttraumatic stress disorder (PTSD), as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, symptoms for 6 months or more and 17-item Clinician-administered PTSD Scale (CAPS-SX17) score of 60 or more. Patients were randomly assigned to receive placebo or flexible doses of venlafaxine ER (37.5-300 mg/d) or sertraline (25-200 mg/d) for 12 weeks or less. The primary outcome was the baseline-to-end point change in total CAPS-SX17 score (last observation carried forward). Secondary measures included CAPS-SX17 symptom cluster scores for reexperiencing/intrusion, avoidance/numbing, and hyperarousal; frequency of remission (CAPS-SX17 < or =20); and changes in Davidson Trauma Scale total score and symptom cluster scores for avoidance/numbing, hyperarousal, and reexperiencing/intrusion. Mean changes in CAPS-SX17 scores were -41.8, -39.4, and -33.9 for venlafaxine ER (P < 0.05 vs. placebo), sertraline, and placebo, respectively. Mean changes for venlafaxine ER, sertraline, and placebo in CAPS-SX17 cluster scores were -13.0, -11.7, and -11.0 for reexperiencing; -17.1, -16.8, and -13.7 (P < 0.05 both active treatments vs. placebo) for avoidance/numbing; and -11.8, -10.9, and -9.2 (P < 0.05 venlafaxine vs. placebo) for hyperarousal. Week 12 remission rates were venlafaxine ER 30.2% (P < 0.05 vs. placebo), sertraline 24.3%, and placebo 19.6%. The venlafaxine ER group had significantly better Davidson Trauma Scale total and cluster scores than placebo. Mean maximum daily doses were 225-mg venlafaxine ER and 151-mg sertraline. Both treatments were generally well tolerated. Study results suggest that venlafaxine ER is effective and well tolerated in the short-term treatment of PTSD.

Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology

“…Probably due to the small size of certain patient sub-groups (men vs women, civilians vs military veterans) neither paroxetine nor sertraline have been found consistently beneficial across all patient groups: though a post hoc analysis suggests that venlafaxine is potentially efficacious in reducing post-traumatic symptom severity in men and women, and across all trauma types [I (PCT)] (Rothbaum et al, 2008a). There have been few controlled comparisons of the effectiveness and acceptability of differing medications, though venlafaxine was found superior to placebo, when sertraline was not [I (PCT)] (Davidson et al, 2006b); reboxetine had similar effectiveness but lower overall tolerability than fluvoxamine [II] (Spivak et al, 2006); and mirtazapine had somewhat greater than effectiveness than sertraline, in a randomised but 'open' trial [II] (Chung et al, 2004).…”

Quality of Care for PTSD and Depression in the Military Health System: Phase I Report

“…A recent review of PTSD pharmacotherapy indicated that the largest and greatest number of trials showing efficacy have been with the SSRIs (Ipser and Stein, 2012). Venlafaxine, an SNRI, has had positive results in two trials with more than 800 participants with non-combat related PTSD (Davidson, Baldwin, et al, 2006;Davidson, Rothbaum, et al, 2006). PTSD practice guidelines from the Society for Traumatic Stress Studies and the American Psychiatric Association echo the recommendations of the VA/DoD CPG (American Psychiatric Association, 2004;Benedek et al, 2009;Foa, Keane and Friedman, 1999).…”

Preclinical Evaluation of Reconsolidation Blockade by Clonidine as a Potential Novel Treatment for Posttraumatic Stress Disorder

“…It has a lifetime prevalence of 6.8% in the United States (Kessler et al, 2005). Current therapeutic strategies include psychotherapy and pharmacological treatments; however, only 60% of patients will be responsive to these treatments (Davidson et al, 2006;Onder et al, 2006) and only 20-30% will achieve full remission (Berger et al, 2009). Consequently, there is a significant need to develop novel pharmacological approaches to reduce symptoms of PTSD.…”