Desvenlafaxine and escitalopram for the treatment of postmenopausal women with major depressive disorder.
OBJECTIVE
This study assessed the efficacy, safety, and tolerability of the serotonin-norepinephrine reuptake inhibitor desvenlafaxine and the selective serotonin reuptake inhibitor escitalopram for major depressive disorder (MDD) in postmenopausal women.


METHODS
In this randomized, double-blind study, postmenopausal outpatients (aged 40-70 y) with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition MDD received flexible-dose desvenlafaxine (100-200 mg/d) or escitalopram (10-20 mg/d) for 8 weeks. Acute-phase responders, that is, women with a 50% or greater reduction from baseline in the 17-item Hamilton Rating Scale for Depression (HAM-D17) total score, were eligible to continue the same double-blind treatment in the 6-month continuation phase. The primary efficacy outcomes were mean change from baseline in HAM-D17 total score (acute phase), analyzed using a mixed-effects model for repeated measures, and the proportion of women who maintained response (continuation phase), analyzed using logistic regression.


RESULTS
Reductions in HAM-D17 total score at acute-phase endpoint were similar for desvenlafaxine- and escitalopram-treated women (-13.6 vs -14.3, respectively; P = 0.24). No significant difference was observed between groups at continuation-phase endpoint in the proportion of women who maintained response (desvenlafaxine, 82%; escitalopram, 80%; P = 0.70). In both phases, desvenlafaxine and escitalopram were generally safe and well tolerated.


CONCLUSIONS
Among postmenopausal outpatients with MDD, there were no significant differences in the efficacy of desvenlafaxine and escitalopram based on primary efficacy analyses. The results do not support the overall hypothesis that the serotonin-norepinephrine reuptake inhibitor desvenlafaxine has an efficacy advantage for the treatment of MDD in postmenopausal women because, in this particular subgroup, desvenlafaxine failed to prove superiority over escitalopram. Safety and tolerability were comparable.
McMaster University, Hamilton, Ontario, Canada. csoares@mcmaster.ca
Claudio N
CN
Soares
Michael E
ME
Thase
Anita
A
Clayton
Christine J
CJ
Guico-Pabia
Kristen
K
Focht
Qin
Q
Jiang
Susan G
SG
Kornstein
Phil
P
Ninan
Cecelia P
CP
Kane
Lee S
LS
Cohen
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D015283:Citalopram / Q000627:therapeutic use*; D003511:Cyclohexanols / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy*; D000069468:Desvenlafaxine Succinate; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008111:Liver Function Tests; D008875:Middle Aged; D014179:Neurotransmitter Uptake Inhibitors / Q000627:therapeutic use*; D017698:Postmenopause; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012890:Sleep; D015430:Weight Gain
D015283:Citalopram; D003511:Cyclohexanols; D000069468:Desvenlafaxine Succinate; D014179:Neurotransmitter Uptake Inhibitors; D017367:Selective Serotonin Reuptake Inhibitors