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Table 1.  

Study Comparisons Remission Rates Odds Ratio (95% Confidence Interval)
Venlafaxine vs all SSRIs 41% vs 35% 1.309 (1.181-1.451)
Venlafaxine vs fluoxetine 42% vs 34% 1.413 (1.221–1.635)
Venlafaxine vs paroxetine 44% vs 39% 1.203 (0.970-1.492)
Venlafaxine vs other SSRIs 37% vs 32% 1.164 (0.925–1.464)
Placebo 24%

Table 1. Remission Rates with Venlafaxine and SSRIs[13]

Achieving Remission in Depression: Raising the Standard of Care

Authors: Martin L. Korn, MDFaculty and Disclosures



The first selective serotonin reuptake inhibitor (SSRI) to be introduced (fluoxetine) was a significant advance in the treatment of depressive disorders. Fluoxetine was simple to administer and had a favorable side effect profile compared with the then available tricyclic antidepressants (TCAs)[1] and monoamine oxidase inhibitors. The SSRIs that were subsequently introduced had similar clinical profiles, and these agents quickly became the treatment of choice in the treatment of depression and anxiety disorders.

Response Vs Remission

Despite the widespread use of the SSRIs, it has become increasingly evident that these agents are often less effective in treating depression compared with some dual-acting agents that affect serotonergic and noradrenergic systems.[2] Early studies that reported similar efficacy rates of all the antidepressant classes tended to use response rather than remission rates as the criterion for improvement. Response is generally defined as a 50% decrease in scores on depression scales, such as the Hamilton Depression Rating Scale (HAMD) or the Montgomery Asberg Depression Rating Scale. Yet significant depressive symptoms are often present after a 50% improvement rate is attained. The patient may therefore have symptomatically improved but still not feel well by the response criterion.

Alternatively, remission is an indicator of wellness. When remission is achieved, the patient experiences few, if any, symptoms of depression. An HAMD score of less than 7 is often used as an indicator of remission, and this more rigorous standard is increasingly being used to judge to effectiveness of a psychopharmacological intervention.[3-6] In addition to the greater functional and symptomatic improvement experienced in the patient who has undergone remission, there is less likelihood of relapse after remission is achieved.[5,7]