Moving from serotonin to serotonin-norepinephrine enhancement with increasing venlafaxine dose: clinical implications and strategies for a successful outcome in major depressive disorder
Issued Date
2023-01-01
Resource Type
ISSN
14656566
eISSN
17447666
Scopus ID
2-s2.0-85166908374
Pubmed ID
37501324
Journal Title
Expert Opinion on Pharmacotherapy
Rights Holder(s)
SCOPUS
Bibliographic Citation
Expert Opinion on Pharmacotherapy (2023)
Suggested Citation
Fagiolini A., Cardoner N., Pirildar S., Ittsakul P., Ng B., Duailibi K., El Hindy N. Moving from serotonin to serotonin-norepinephrine enhancement with increasing venlafaxine dose: clinical implications and strategies for a successful outcome in major depressive disorder. Expert Opinion on Pharmacotherapy (2023). doi:10.1080/14656566.2023.2242264 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/88341
Title
Moving from serotonin to serotonin-norepinephrine enhancement with increasing venlafaxine dose: clinical implications and strategies for a successful outcome in major depressive disorder
Other Contributor(s)
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.