Moving from serotonin to serotonin-norepinephrine enhancement with increasing venlafaxine dose: clinical implications and strategies for a successful outcome in major depressive disorder.

Abstract

INTRODUCTION:

Mental health disorders, especially depressive and anxiety disorders, are associated with substantial health-related burden. While the second-generation antidepressants are widely accepted as first-line pharmacological treatment for major depressive disorder (MDD), patient response to such treatment is variable, with more than half failing to achieve complete remission, and residual symptoms are frequently present.

AREAS COVERED:

Here, the pharmacodynamics of venlafaxine XR are reviewed in relation to its role as both a selective serotonin reuptake inhibitor (SSRI) and a serotonin-norepinephrine-reuptake inhibitor (SNRI), and we look at how these pharmacodynamic properties can be harnessed to guide clinical practice, asking the question 'is it possible to develop a symptom-cluster-based approach to the treatment of MDD with comorbid anxiety utilizing venlafaxine XR?.' Additionally, three illustrative clinical cases provide practical examples of the utility of venlafaxine-XR in real-world clinical practice. The place of venlafaxine XR in managing fatigue/low energy, a frequent residual symptom in MDD, is explored using pooled data from clinical trials of venlafaxine XR.

EXPERT OPINION:

Venlafaxine XR should be considered as a first-line treatment for MDD with or without comorbid anxiety, and there are clear pharmacodynamic signals supporting a symptom cluster-based treatment paradigm for venlafaxine XR.

• Authors: Andrea Fagiolini, Narcis Cardoner, Sebnem Pirildar, Pichai Ittsakul, Bernardo Ng, Kalil Duailibi, Nasser El Hindy
• Journal: Expert opinion on pharmacotherapy (Expert Opin Pharmacother) 2023 Sep-Dec Vol. 24 Issue 15 Pg. 1715-1723 ISSN: 1744-7666 [Electronic] England
• PMID: 37501324 (Publication Type: Journal Article, Review)

Chemical References

• Venlafaxine Hydrochloride
• Serotonin
• Norepinephrine
• Selective Serotonin Reuptake Inhibitors
• Antidepressive Agents, Second-Generation
• Cyclohexanols
• Delayed-Action Preparations

Topics

• Humans
• Venlafaxine Hydrochloride (therapeutic use)
• Depressive Disorder, Major (drug therapy)
• Serotonin (therapeutic use)
• Norepinephrine (therapeutic use)
• Selective Serotonin Reuptake Inhibitors (therapeutic use)
• Antidepressive Agents, Second-Generation (therapeutic use)
• Cyclohexanols (therapeutic use)
• Treatment Outcome
• Delayed-Action Preparations