Comparison of Venlafaxine and Fluoxetine in the Treatment of Postmenopausal Women With Major Depression
Status:
Completed
Trial end date:
2017-03-16
Target enrollment:
Participant gender:
Summary
Women are more prone to depression at certain points of the life cycle, although the
etiologic and therapeutic implications remain largely unknown1,2. It is reported that pre-
and postmenopausal women have a significant difference in response to some antidepressants,
within a large clinical trial data set3, 4. A growing number of researches indicate that a
woman's hormonal status may influence response to different forms of antidepressant
medication. Specifically, younger women appeared to respond better to monoamine oxidase
inhibitors (MAOIs) and selective serotonin reuptake inhibitor (SSRIs), whereas men and older
women have tended to have relatively better responses to tricyclic antidepressants (TCAs)
1-5. One difference between these classes of antidepressants is that the SSRIs are strongly
serotoninergic, whereas TCAs have predominantly noradrenergic effects. One pooled analysis 6
suggests that older women (age ≥ 50) tend to respond poorer to SSRI, while this phenomenen
was not observed with venlafaxine.
The antidepressive mechanism of venlafaxine that has both noradrenergic and serotonergic
effects is superior to SSRIs. As a noradrenergic and serotonergic antidepressant,
venlafaxinee has been demonstrated of significant advantages in response and remission rates
compared with various SSRIs. As mentioned above, older women tend to have relatively better
responses to TCAs which is predominantly noradrenergic antidepressant. Postmenopausal women
with depression also would be predicted to respond better to an SSRI if administered along
with hormone replacement therapy 6. This could be critical to understanding age difference in
antidepressant responses across the life cycle because circulating estrogen levels may
modulate central serotoninergic pathways. Therefore, it is presumed that antidepressants
which enhance both serotonergic and noradrenergic neurotransmission, as venlafaxine, may be
more effective than SSRIs for postmenopausal women with major depressive disorder.