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
Escitalopram provides a more cost-effective first-line treatment of depression than generic venlafaxine XR.
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 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
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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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