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Venlafaxine

Venlafaxine (Effexor) versus Other Antidepressants

Venlafaxine (Effexor) vs. Escitalopram (Lexapro)
  • Efficacy:
    Major depressive disorder: In the double-blind comparison there were no significant differences in measures of efficacy between escitalopram and venlafaxine. Remission rates were 41.2% for escitalopram and 36.7% for venlafaxine XR. Response rates for the escitalopram and venlafaxine XR groups were 58.8% and 48.0%, respectively 8. Escitalopram has a faster onset of antidepressant effects 9.
  • Side effects: Escitalopram appears to be significantly better tolerated than venlafaxine XR 8.
  • Withdrawal symptoms: Venlafaxine is associated with significantly higher rate of discontinuation symptoms than escitalopram 8, 9.
  • Cost:
    Escitalopram provides a more cost-effective first-line treatment of depression than generic venlafaxine XR.

Venlafaxine (Effexor) vs. Sertraline (Zoloft)
  • Efficacy:
    • Major depressive disorder: Response rate is higher with Venlafaxine than with Sertraline in the major depressive disorder. The remission rate with venlafaxine (67%) is significantly higher than with sertraline (36%) 19, 20.
    • Bipolar depression: There is a significantly increased risk of switches into hypomania or mania with venlafaxine compared with sertraline treatment 2.
  • Side effects: Most common adverse events with venlafaxine are nausea, headache, and sweating and with sertraline are nausea, headache, and diarrhea 3. Venlafaxine is associated with the risk of blood pressure increase 9. Antidepressant-induced sexual dysfunction occurs more frequently with sertraline, than with venlafaxine 21.
  • Discontinuation syndrome: Sertraline may be associated with a lower symptom burden during treatment discontinuation 22.

Venlafaxine (Effexor) vs. Paroxetine (Paxil)
  • Efficacy:
    Major depressive disorder: In clinical study venlafaxine showed some evidence of superiority to paroxetine in the treatment-resistant depression. In patients with non-chronic treatment-resistant depression the response rate was 51.9% for venlafaxine and 32.7% for paroxetine, and a remission was achieved in 42.3% of venlafaxine-treated and 20.0% of paroxetine-treated patients 13.
    Venlafaxine appears to have a higher rate of response and remission in patients with depressive disorder or dysthymia. In clinical study a response was achieved in 55% of patients on venlafaxine and 29% on paroxetine after 6 weeks of treatment. After 12 weeks, significantly more patients in the venlafaxine group had a HAM-D remission score of 8 or less (59% versus 31%) 14.
  • Obsessive-compulsive disorder: Paroxetine is more efficacious than venlafaxine in the treatment of nonresponders to a previous SSRI trial 15.
  • Panic disorder: In randomized controlled trial patients treated with venlafaxine ER had significantly greater mean Panic Disorder Severity Scale score improvement than patients treated with the paroxetine and a significantly higher proportion of patients free of full symptom panic attacks (70.0 vs 58.3%) 16.
  • Social anxiety disorder: Venlafaxine ER appears to be effective treatment for SAD, with efficacy and tolerability comparable to paroxetine. In clinical study after 12 week of the treatment response rates were 58.6% for the venlafaxine ER and 62.5% for paroxetine 17.
  • Bipolar depression: Paroxetine and venlafaxine are both effective and safe in the treatment of depressive breakthrough episodes in bipolar disorder. There is a slightly higher risk for switch to mania or hypomania with venlafaxine 18.

Venlafaxine (Effexor) vs. Amitriptyline (Elavil)
  • Efficacy:
    • Migraine prophylaxis: Both venlafaxine and amitriptyline have significant beneficial effect on pain parameters 4.
    • Major depression: Both are effective in the treatment of depression. There are no significant differences between drugs in efficacy 5.
      Venlafaxine can improve social functioning more than amitriptyline. This effect may be linked to the higher rate of side-effects with amitriptyline 6.
  • Side effects: Venlafaxine is associated with the lower rate of adverse effects4, 5.

Venlafaxine (Effexor) vs. Mirtazapine (Remeron)
  • Efficacy:
    Major depressive disorder: Mirtazapine appears to have higher response and remission rates than venlafaxine 1.
    Mirtazapine orally disintegrating tablets (ODT) has a faster onset of antidepressant efficacy than venlafaxine XR 3.
  • Side effects: Mirtazapine is associated with significantly fewer dropouts due to adverse events 1.
Venlafaxine (Effexor) vs. Trazodone (Desyrel)
  • Efficacy:
    Major depressive disorder: Venlafaxine can produce more improvement in the cognitive disturbance and retardation factors on the Hamilton Rating Scale for Depression. Trazodone is more effective against the sleep disturbance factor 23. Trazodone efficiency in comparison to venlafaxine is faster, so trazodone is characterized by potentially quicker beginning of activity in patients with depression disorders 24.
  • Side effects: Venlafaxine is most likely to cause nausea, whereas trazodone is associated with the most dizziness and somnolence 23. Libido decrease is common side effect with venlafaxine treatment 24.

Further reading
References
  • 1. Guelfi JD, Ansseau M, Timmerman L, K?rsgaard S; Mirtazapine-Venlafaxine Study Group. Mirtazapine versus venlafaxine in hospitalized severely depressed patients with melancholic features. J Clin Psychopharmacol. 2001 Aug;21(4):425-31. PubMed
  • 3. Benkert O, Szegedi A, Philipp M, Kohnen R, Heinrich C, Heukels A, van der Vegte-Senden M, Baker RA, Simmons JH, Schutte AJ. Mirtazapine orally disintegrating tablets versus venlafaxine extended release: a double-blind, randomized multicenter trial comparing the onset of antidepressant response in patients with major depressive disorder. J Clin Psychopharmacol. 2006 Feb;26(1):75-8. PubMed
  • 4. Bulut S, Berilgen MS, Baran A, Tekatas A, Atmaca M, Mungen B. Venlafaxine versus amitriptyline in the prophylactic treatment of migraine: randomized, double-blind, crossover study. Clin Neurol Neurosurg. 2004 Dec;107(1):44-8. PubMed
  • 5. Benedictis E. Double-blind comparison of venlafaxine and amitriptyline in outpatients with major depression with or without melancholia. J Psychopharmacol. 2000 Mar;14(1):61-6. PubMed
  • 6. Gorenstein C, Andrade L, Moreno RA, Artes R. Social adjustment in depressed patients treated with venlafaxine and amitriptyline. Int Clin Psychopharmacol. 2002 Jul;17(4):171-5.
  • 7. Thase ME, Clayton AH, Haight BR, Thompson AH, Modell JG, Johnston JA. A double-blind comparison between bupropion XL and venlafaxine XR: sexual functioning, antidepressant efficacy, and tolerability. J Clin Psychopharmacol. 2006 Oct;26(5):482-8. PubMed
  • 8. Bielski RJ, Ventura D, Chang CC. A double-blind comparison of escitalopram and venlafaxine extended release in the treatment of major depressive disorder. J Clin Psychiatry. 2004 Sep;65(9):1190-6. PubMed
  • 9. Montgomery SA, Huusom AK, Bothmer J. A randomised study comparing escitalopram with venlafaxine XR in primary care patients with major depressive disorder. Neuropsychobiology. 2004;50(1):57-64. PubMed
  • 13. Poirier MF, Boyer P. Venlafaxine and paroxetine in treatment-resistant depression. Double-blind, randomised comparison. Br J Psychiatry. 1999 Jul;175:12-6. PubMed
  • 14. Ballu's C, Quiros G, De Flores T, de la Torre J, Palao D, Rojo L, Gutie'rrez M, Casais L, Riesgo Y. The efficacy and tolerability of venlafaxine and paroxetine in outpatients with depressive disorder or dysthymia. Int Clin Psychopharmacol. 2000 Jan;15(1):43-8. PubMed
  • 15. Denys D, van Megen HJ, van der Wee N, Westenberg HG. A double-blind switch study of paroxetine and venlafaxine in obsessive-compulsive disorder. J Clin Psychiatry. 2004 Jan;65(1):37-43. PubMed
  • 16. Pollack M, Mangano R, Entsuah R, Tzanis E, Simon NM. A randomized controlled trial of venlafaxine ER and paroxetine in the treatment of outpatients with panic disorder. Psychopharmacology (Berl). 2007 Jun 23. PubMed
  • 17. Liebowitz MR, Gelenberg AJ, Munjack D. Venlafaxine extended release vs placebo and paroxetine in social anxiety disorder. Arch Gen Psychiatry. 2005 Feb;62(2):190-8. PubMed
  • 18. Vieta E, Martinez-Ara'n A, Goikolea JM, Torrent C, Colom F, Benabarre A, Reinares M. A randomized trial comparing paroxetine and venlafaxine in the treatment of bipolar depressed patients taking mood stabilizers. J Clin Psychiatry. 2002 Jun;63(6):508-12. PubMed
  • 19. Mehtonen OP, Sogaard J, Roponen P, Behnke K. Randomized, double-blind comparison of venlafaxine and sertraline in outpatients with major depressive disorder. Venlafaxine 631 Study Group. J Clin Psychiatry. 2000 Feb;61(2):95-100 PubMed
  • 20. Einarson TR, Arikian SR, Casciano J, Doyle JJ. Comparison of extended-release venlafaxine, selective serotonin reuptake inhibitors, and tricyclic antidepressants in the treatment of depression: a meta-analysis of randomized controlled trials. Clin Ther. 1999 Feb;21(2):296-308. PubMed
  • 21. Kennedy SH, Eisfeld BS, Dickens SE, Bacchiochi JR, Bagby RM. Antidepressant-induced sexual dysfunction during treatment with moclobemide, paroxetine, sertraline, and venlafaxine. J Clin Psychiatry. 2000 Apr;61(4):276-81. PubMed
  • 22. Sir A, D'Souza RF, Uguz S, George T, Vahip S, Hopwood M, Martin AJ, Lam W, Burt T. Randomized trial of sertraline versus venlafaxine XR in major depression: efficacy and discontinuation symptoms. J Clin Psychiatry. 2005 Oct;66(10):1312-20. PubMed
  • 23. Cunningham LA, Borison RL, Carman JS, Chouinard G, Crowder JE, Diamond BI, Fischer DE, Hearst E. A comparison of venlafaxine, trazodone, and placebo in major depression. J Clin Psychopharmacol. 1994 Apr;14(2):99-106. PubMed
  • 24. Florkowski A, Gruszczynski W, Galecki P, Zboralski K, Kolodziejska I, Mikolajczyk I. Trazodone and venlafaxine in treatment of depressive disorders. Pol Merkur Lekarski. 2005 May;18(107):556-9. PubMed
  • 25. Nordström G, Danchenko N, Despiegel N, Marteau F. Cost-effectiveness evaluation in Sweden of escitalopram compared with venlafaxine extended-release as first-line treatment in major depressive disorder. Value Health. 2012 Mar-Apr;15(2):231-9. PubMed

Published: March 31, 2008
Last updated: July 07, 2014

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