Venlafaxine (Effexor) versus Other Antidepressants
Venlafaxine (Effexor) vs. Escitalopram (Lexapro)
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
Venlafaxine (Effexor) vs. Fluoxetine (Prozac)
Major depressive disorder: Venlafaxine appears to be superior
to fluoxetine and prodeces higher rate of remission in the treatment
for depression 10. Venlafaxine's
superior remission rates in the more severely anxious patients and
its ability to improve psychic anxiety compared with fluoxetine suggest
that venlafaxine's early efficacy on anxiety symptoms may be the basis
for its superior efficacy in depression 11.
- Drug interactions: Fluoxetine has a higher potential
for drug interactions with drugs metabolized by CYP2D6 (e.g. amphetamines,
selected beta-blockers, dextromethorphan, lidocaine, mirtazapine,
nefazodone, paroxetine, risperidone, ritonavir, thioridazine, tricyclic
Venlafaxine (Effexor) vs. Sertraline (Zoloft)
- Major depressive disorder: Response rate is higher with Venlafaxine
than with Sertraline in the major depressive disorder. The remission
rate with venlafaxine (67%) is significanly 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
sexual dysfunction occurs more frequently with sertraline, than with
- Discontinuation syndrome: Sertraline may be associated
with a lower symptom burden during treatment discontinuation 22.
Venlafaxine (Effexor) vs. Paroxetine (Paxil)
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
- 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)
- 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
- Side effects: Venlafaxine is associated with the lower
rate of adverse effects4,
Venlafaxine (Effexor) vs. Mirtazapine (Remeron)
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)
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.
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Published: March 31, 2008
Last updated: March 24, 2014