Efficacy and tolerability of venlafaxine in patients hospitalized with moderate to severe depression: an open-label pilot study

Among the latest generation of antidepressants, venlafaxine has been well characterized in terms of dosage, dose-response relationship, metabolic pattern, tolerability, and safety profile. The aim of this naturalistic open-label study was to contribute further information on the efficacy and tolerability of venlafaxine in patients hospitalized with moderate to severe depression. Twenty-three patients were included in the study; all patients underwent a complete assessment at baseline, on days 4, 7, and 14, and at discharge. At baseline, 2 semistructured clinical interviews for the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, were used for the diagnosis of axis I (mental) and II (personality) disorders. The primary efficacy variables were the mean changes from baseline in the total scores for the Hamilton Rating Scale for Depression, the Montgomery Asberg Depression Rating Scale, and the Clinical Global Impression Scale. Thirteen patients (56.5%) had recurrent; major depression; for 5 patients (21.7%) this was their first episode. The remaining 5 patients (21.7%) had various bipolar disorders, mood disorder caused by a medical condition, or dysthymia. Twelve (52.2%) of the 23 patients had a personality disorder. The mean dose of venlafaxine was 68.5 +/- 14.5 mg/d initially and 207.1 +/- 52.9 at discharge. Patients also received a benzodiazepine (n = 11); a benzodiazepine and a neuroleptic (n = 7); a benzodiazepine and a mood stabilizer (n = 3); or a benzodiazepine, a neuroleptic, and a mood stabilizer (n = 2). Venlafaxine led to a significant reduction from baseline in all primary efficacy variables, beginning on day 4 and continuing to discharge. Venlafaxine appeared to have a rapid onset of action, although this finding could have been influenced by titration of the dose of venlafaxine more quickly than was recommended. Although this was an open-label study subject to various limitations, results indicated good efficacy and tolerability of venlafaxine in patients hospitalized with moderate to severe depression.