title: Comparisons of the efficacy and tolerability of extended-release venlafaxine, mirtazapine, and paroxetine in treatment-resistant depression: a double-blind, randomized pilot study in a Chinese population.
abstract: To compare the efficacy and tolerability of antidepressants switch with extended-release venlafaxine (venlafaxine-XR), mirtazapine, and paroxetine in Chinese patients with major depressive disorder who had 2 consecutive unsuccessful antidepressant trials. One hundred fifty adult patients with treatment-resistant depression according to their medical records and/or response to current treatments were randomly assigned to receive fixed-dosage treatment of venlafaxine-XR 225 mg/d (n = 50), mirtazapine 45 mg/d (n = 55), or paroxetine 20 mg/d (n = 45) for 8 weeks. The primary outcome was the remission rates that were defined as a score 7 or lower on the 17-item Hamilton Rating Scale for Depression (HRSD-17). Secondary outcomes included the remission rate defined by the Self-Rating Depression Scale of 50 or lower and the response rate defined by a 50% reduction or greater on the HRSD-17 total score, and the improvement of patients' general health functions. The completion rates were 82% for venlafaxine-XR, 81.8% for mirtazapine, and 82.2% for paroxetine. Only one patient in paroxetine arm discontinued the study owing to an adverse event. The remission rates based on the HRSD-17 were 42.0% for venlafaxine-XR, 36.4% for mirtazapine, and 46.7% for paroxetine. There were no statistical significances between treatment arms in remission rates. Similarly, there were also no significant differences between groups in secondary outcome measure. Venlafaxine-XR, mirtazapine, and paroxetine were equally effective in the treatment of Chinese patients with major depressive disorder who failed at least 2 previous antidepressant treatments. Selecting any of these 3 antidepressants as a third-step antidepressant is a reasonable choice for this group of patients.
authors.affiliation: Shanghai Mental Health Center, School of Medicine, Shanghai Jiaotong University, Shanghai, China. yirufang@yahoo.com.cn
authors.forename: Yiru
authors.initials: Y
authors.lastname: Fang
authors.forename: Chengmei
authors.initials: C
authors.lastname: Yuan
authors.forename: Yifeng
authors.initials: Y
authors.lastname: Xu
authors.forename: Jun
authors.initials: J
authors.lastname: Chen
authors.forename: Zhiguo
authors.initials: Z
authors.lastname: Wu
authors.forename: Lan
authors.initials: L
authors.lastname: Cao
authors.forename: Zhenghui
authors.initials: Z
authors.lastname: Yi
authors.forename: Wu
authors.initials: W
authors.lastname: Hong
authors.forename: Yong
authors.initials: Y
authors.lastname: Wang
authors.forename: Kaida
authors.initials: K
authors.lastname: Jiang
authors.forename: Keming
authors.initials: K
authors.lastname: Gao
authors.forename: Xingjia
authors.initials: X
authors.lastname: Cui
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Nierenberg
mesh_terms: D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000627:therapeutic use; D002681:China; D003511:Cyclohexanols / Q000009:adverse effects / Q000627:therapeutic use*; D003692:Delayed-Action Preparations; D003865:Major Depressive Disorder / Q000188:drug therapy*; D004311:Double-Blind Method; D004351:Drug Resistance; D005260:Female; D006801:Humans; D008297:Male; D008803:Mianserin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008875:Middle Aged; D000078785:Mirtazapine; D017374:Paroxetine / Q000009:adverse effects / Q000627:therapeutic use*; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D012074:Remission Induction / Q000379:methods; D016896:Treatment Outcome; D000069470:Venlafaxine Hydrochloride
chemical_list: D018687:Antidepressive Agents, Second-Generation; D000929:Antidepressive Agents, Tricyclic; D003511:Cyclohexanols; D003692:Delayed-Action Preparations; D008803:Mianserin; D017374:Paroxetine; D000069470:Venlafaxine Hydrochloride; D000078785:Mirtazapine