Therapeutic Options for Treating Major Depression, and the Role of Venlafaxine

Abstract

Major depression is a debilitating disorder that is often undertreated. Psychotherapy, electroconvulsive therapy, and pharmacotherapy are options for management. Tricyclic antidepressants and selective serotonin reuptake inhibitors are the cornerstones of drug therapy. Venlafaxine, a phenylethylamine antidepressant that primarily inhibits reuptake of norepinephrine and serotonin, is an alternative to those agents. It has been studied in short‐term and continuation studies and appears to have efficacy similar to that of imipramine, trazodone, and fluoxetine. Moreover, venlafaxine is effective in approximately one‐third of patients with treatment‐resistant depression. Venlafaxine is metabolized by the P‐450 enzyme system to an active metabolite O‐desmethyl‐venlafaxine, which is excreted renally. Nausea, somnolence, and dizziness are dose‐related adverse effects that often occur with initiation of therapy. Increases in blood pressure, particularly with high dosages, also may occur. Drug‐drug interactions appear to be minimal.