Outcomes Following a Switch to Duloxetine or Venlafaxine in Treatment of Residual Symptoms of Depressed Patients

OBJECTIVE To explore the efficacy and safety of switching to duloxetine or venlafaxine in treatment of poorly-response-to-selective serotonin reuptake inhibitor(SSRI) first-episode depressed patients. METHODS The 96 patients with first-episode major depressive disorder(MDD) who had poor efficacy or residual symptoms after treatment with SSRIs were recruited and simply randomized into two groups for a 12-weeks prospective study, they were given variable dose duloxetine or venlafaxine respectively after washout period, and were assessed with the scales of Hamilton Depression Scale (HAMD-17), Hamilton Anxiety Scale(HAMA), Treatment Emergent Symptom Scale(TESS), Snaith-Hamilton Pleasure Scale (SHAPS) and Temporal Experience Pleasure Scale(TEPS) at baseline and 2nd, 4th, 6th, 8th, 12th weekends, the efficacy and safety between the two groups were analyze and evaluate at endpoint. RESULTS Total response rate and remission rate of patients were 73.96% and 39.58% respectively at 12th weekend after switching to serotonin and noradrenaline reuptake inhibitor(SNRI). Scores of HAMD-17, HAMA, SHAPS and TEPS at endpoint were much better than which at baseline(P<0.05 or P<0.01). The efficacy between duloxetine group and venlafaxine group showed no statistical difference (P>0.05), and the by-effects were similar in two groups, mainly including dry mouth, constipation, fatigue, sexual dysfunction and so on, but blood pressure increased higher in venlafaxine group than in duloxetine group(P<0.05). CONCLUSION Depressive symptoms including anhedonia resistant to SSRI could be improved by SNRI effectively. Duloxetine is as effective and safe as venlafaxine, but venlafaxine may increase blood pressure and should be used with caution in patients with hypertension.