Both venlafaxine and duloxetine are safe and effective options for the treatment of depression and generalised anxiety disorder in primary care, according to a new review carried out by researchers at the Maudsley Hospital in London.
The serotonin nor adrenaline reuptake inhibitor (SNRI) venlafaxine had primary care prescribing restrictions placed on it in 2004 due to concerns about cardiotoxicity and mortality in overdose. Although a review of the evidence led to a reversal of the majority of restrictions in 2006, the researchers say there is GPs may still be cautious in their prescribing of venlafaxine and possibly other SNRI antidepressants.
Their review – published in Therapeutic Advances in Psychopharmacology – looked at the safety of SNRI antidepressants from a perspective of cardiovascular safety and overdose. They say current evidence suggests a marginally higher toxicity of venlafaxine in overdose compared with another SNRI duloxetine and SSRIs – although this may be related to differential patterns of prescribing in high-risk patients.
Based on this review – they conclude – SNRIs have a positive risk benefit profile in the treatment of depression and generalized anxiety disorder in primary care, especially as second-line agents to SSRIs.