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Published on: January 7, 2019
Short-term venlafaxine v. lithium monotherapy for bipolar type II major depressive episodes: effectiveness and mood
Jay D Amsterdam1, Lorenzo Lorenzo-Luaces2, Irene Soeller2
1Jay D. Amsterdam, MD, Depression Research Unit, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA; Lorenzo Lorenzo-Luaces, MA, Depression Research Unit, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania School of Medicine, Philadelphia and Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania; Irene Soeller, MSN, Susan Qing Li, MS, Depression Research Unit, Department of Psychiatry and Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Jun J. Mao, MD, Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Robert J. DeRubeis, PhD, Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA jamsterd@mail.med.upenn.edu.
Background:
Controversy exists over antidepressant use in bipolar II depression.
Aims:
To compare the safety and effectiveness of antidepressantv.mood stabiliser monotherapy for bipolar type II major depressive episodes.
Method:
Randomised, double-blind, parallel-group, 12-week comparison of venlafaxine (n= 65)v.lithium (n= 64) monotherapy in adult out-patients (trial registration numberNCT00602537).
Results:
Primary outcome - venlafaxine produced a greater response rate (67.7%)v lithium (34.4%,P<0.001). Secondary outcomes - venlafaxine produced a greater remission rate (58.5%v 28.1%,P<0.001); greater decline in depression symptom scores over time (β = -5.32, s.e. = 1.16, χ(2)= 21.19,P<0.001); greater reduction in global severity scores over time (β = -1.05, s.e. = 0.22, w(2)= 22.33,P<0.001); and greater improvement in global change scores (β = -1.31, s.e. = 0.32, χ(2)= 16.95,P<0.001) relative to lithium. No statistically significant or clinically meaningful differences in hypomanic symptoms were observed between treatments.
Conclusions:
These findings suggest that short-term venlafaxine monotherapy may provide effective antidepressant treatment for bipolar II depression without a statistically significant increase in hypomanic symptoms relative to lithium.
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