Previous Antidepressant Use May Predict Remission With Venlafaxine in MDD

older man looking sad
older man looking sad
Investigators found data that showed that patients with major depressive disorder who had been treated with more than 2 antidepressants, including an SNRI, showed a low likelihood of response to venlafaxine at any dosage.

Older adults with major depressive disorder may be less likely to experience remission with venlafaxine if they have previously participated in adequate antidepressant trials, according to study results published in the Journal of Clinical Psychiatry.

In addition, the study found that patients who had never been treated with a serotonin-norepinephrine reuptake inhibitor (SNRI) were more likely to respond to venlafaxine than patients who had previously tried an SNRI.

The study included 500 older adults (mean age, 68.62 years) with major depressive disorder who were included in the National Institute of Mental Health-funded IRL-GREY ( Identifier: NCT00892047) and unpublished IRL-GREY-B (Incomplete Response in Late- Life Depression: Getting to Remission with Buprenorphine) trials. All patients were treated with extended-release venlafaxine capsules for 12 weeks.

For the purposes of this study, researchers obtained and analyzed data on patients’ prior antidepressant trial participation for the current depressive episode. In addition, remission rates in relation to the number and class of previous antidepressant trials were examined in a post hoc analysis from the 2 trials.

Of 93 patients who had no history of prior medication trials, approximately 67% achieved remission. Conversely, 66% of patients with prior inadequate treatment and 39% of patients with prior adequate treatment achieved remission (P <.0001 for the comparison of no prior trials, only inadequate trials, and ≥1 adequate trials).

An additional analysis — “no prior adequate medication trials” — found an inverse correlation between remission rates with venlafaxine and the number of prior adequate medication trials (no prior adequate trials [66%] vs 1 prior adequate trial [45%] vs ≥2 prior adequate trials [23%]; P <.0001). Patients in ≥2 prior treatment trials that included an SNRI were even less likely to achieve remission with venlafaxine (1 prior adequate trial [32%] vs ≥2 prior adequate trials [18%]; P <.0001).

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Study limitations were the inclusion of only older adults with major depressive disorder, as well as the inclusion of data from open-label clinical trials.

Findings from this study suggest “that a careful evaluation of prior adequate medication trials, in terms of both number and class, can help clinicians to optimize the selection of the next step that should be tried when treating depression.”


Buchalter ELF, Oughli HA, Lenze EJ, et al. Predicting remission in late-life major depression: a clinical algorithm based upon past treatment history. J Clin Psychiatry. 2019;80(6):pii: 18m12483. doi:10.4088/JCP.18m12483