title: Re-evaluation of the efficacy and tolerability of venlafaxine vs SSRI: meta-analysis.
abstract: BACKGROUND
  A number of reviews have claimed that the selective serotonin and noradrenalin re-uptake inhibitor venlafaxine is more effective than selective serotonin re-uptake inhibitors (SSRIs) in achieving remission and symptom reduction in major depression.
  
  
  OBJECTIVE
  The aim of this study was to systematically review studies on the efficacy of venlafaxine vs SSRI and to evaluate the influence of methodological issues on the effect sizes.
  
  
  METHODS
  Following a systematic literature search, we pooled data on depression scores, response, remission and dropout rates. We also performed sub-group analyses.
  
  
  RESULTS
  Seventeen studies were included. We found no significant superiority in remission rates (risk ratio [RR] = 1.07, 95% confidence intervals [95%CI] = 0.99 to 1.15, numbers needed to treat [NNT] = 34) and a small superiority in response rates (RR = 1.06, 95%CI = 1.01 to 1.12, NNT = 27) over SSRIs. There was a small advantage to venlafaxine in change scores (effect size = -0.09, 95%CI = -0.16 to -0.02, p = 0.013), which did not reach significance when post-treatment scores were used (effect size = -0.06, 95%CI = -0.13 to 0.00). Discontinuation rates due to adverse events were 45% higher in the venlafaxine group. The main reasons for the differences between this analysis and previous reviews were the exclusion of studies with methodological limitations, avoiding to pool selectively reported study results and exclusion of studies available as abstracts only.
  
  
  CONCLUSIONS
  Our analysis does not support a clinically significant superiority of venlafaxine over SSRIs. Differences between our study and previous reviews were not accounted for by technical aspects of data synthesis, but rather by study selection and choice of outcome parameters.
authors.affiliation: University of Ulm, Ulm, Germany. stefan.weinmann@gmx.de
authors.forename: S
authors.initials: S
authors.lastname: Weinmann
authors.forename: T
authors.initials: T
authors.lastname: Becker
authors.forename: M
authors.initials: M
authors.lastname: Koesters
mesh_terms: D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000627:therapeutic use*; D003511:Cyclohexanols / Q000009:adverse effects / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy*; D006801:Humans; D010352:Patient Dropouts; D012074:Remission Induction; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D000069470:Venlafaxine Hydrochloride
chemical_list: D018687:Antidepressive Agents, Second-Generation; D003511:Cyclohexanols; D017367:Selective Serotonin Reuptake Inhibitors; D000069470:Venlafaxine Hydrochloride