目前市場上治療抑郁癥的藥物有很多種,，但依然有很多抑郁癥患者無法治愈,。2008年2月的愛思唯爾期刊《生物精神病學(xué)》（Biological Psychiatry）發(fā)表的一篇文章，對SNRIs類和SSRIs類抗抑郁藥物的療效進行了對比研究,。
研究人員綜合分析了34個雙盲隨機控制試驗，SNRIs類藥物選用了文拉法辛,。文章第一作者Charles Nemeroff博士說：“文拉法辛的效果整體上優(yōu)于SSRIs類藥物,。由于副作用,，很多文拉法辛受試者中途退出試驗。”研究發(fā)現(xiàn)文拉法辛在有效率比SSRIs類藥物高5.9%,。
《生物精神病學(xué)》雜志的編輯,，同時還受聘于耶魯大學(xué)醫(yī)學(xué)院和美國退役軍人協(xié)會康涅狄格醫(yī)療服務(wù)系統(tǒng)的醫(yī)學(xué)博士John H. Krystal說：“這篇文章的研究結(jié)論對公共衛(wèi)生有很重要的意義。”他進一步解釋說,，如果一名醫(yī)生一開始用SSRI類藥物診治200名抑郁癥患者,。后來，他改用文拉法辛治療,，那么將有12名患者從改變用藥中獲益,。這只是一個小數(shù)目，但如果占全美人口7.1%（2100多萬人）的抑郁癥患者都改用文拉法辛,，那么有效率提高5.9%將意味著超過一百萬人有了治愈抑郁癥的希望,。（科學(xué)網(wǎng) 荔濤/編譯）
生物谷推薦原始出處：
（Biological Psychiatry），doi:10.1016/j.biopsych.2007.06.027 ,，Charles B. Nemeroff, Michael E. Thase
Comprehensive Analysis of Remission (COMPARE) with Venlafaxine versus SSRIs Charles B. Nemeroffa, , , Richard Entsuahb, Isma Benattiab, Mark Demitrackb, Diane M. Sloanc and Michael E. Thased
aDepartment of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
bWyeth Research, Collegeville, Pennsylvania
cAdvogent, Wayne, New Jersey
dDepartment of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Received 3 November 2006; revised 17 May 2007; accepted 6 June 2007. Available online 24 September 2007.
Background
To compare venlafaxine and selective serotonin reuptake inhibitors (SSRIs; fluoxetine, sertraline, paroxetine, fluvoxamine, and citalopram) in the treatment of depression.
Methods and Materials
Meta-analysis of 34 randomized, double-blind studies identified by a worldwide search of all research sponsored by Wyeth Pharmaceuticals through January 2007. Patients were treated with venlafaxine (n = 4191; mean dose 151 mg/day) or SSRIs (n = 3621); nine studies also included a placebo control group (n = 932). The primary outcome measure was intent-to-treat (ITT) remission rates (Hamilton Rating Scale for Depression ≤7) at week 8.
Results
The overall difference in ITT remission rates was 5.9% favoring venlafaxine (95% confidence interval [CI]: .038–.081; p < .001). Based on this difference, the number needed to treat (NNT) to benefit is 17 (95% CI: 12–26). In the nine placebo controlled studies, the drug-placebo differences were 6% (.02–.09) for the SSRIs and 13% (.09–.16) for venlafaxine. For the specific SSRIs, the difference versus fluoxetine (mean dose = 37 mg/day; 20 studies) was significant (6.6% [95% CI: .030–.095]); smaller differences versus paroxetine (mean dose = 25 mg/day; eight studies; 5%), sertraline (mean dose = 127 mg/day; three studies; 3%), and citalopram (mean dose = 38 mg/day; two studies; 4%) were not significant. Attrition rates due to adverse events were higher with venlafaxine than with SSRI therapy, 11% and 9% respectively (p = .0011).
Conclusions
These results indicate that venlafaxine therapy is statistically superior to SSRIs as a class, but only to fluoxetine individually. The clinical significance of this modest advantage seems limited for the broad grouping of major depressive disorder. Nonetheless, an NNT of 17 may be of public health relevance given the large number of patients treated for depression and the significant burden of illness associated with this disorder.
