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Chapter 22. Venlafaxine and Desvenlafaxine

Michael E. Thase, M.D.; Diane M. Sloan, Pharm.D.
DOI: 10.1176/appi.books.9781585623860.427499

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The drug known as venlafaxine was first synthesized in the early 1980s and was found to block the uptake of serotonin (5-HT) and, with lower potency, norepinephrine (NE), in rat brain synaptosomal preparations (Muth et al. 1986). Subsequently, it was shown to have in vivo activity in animal models of depression and to have little affinity for muscarinic or histaminergic postsynaptic receptors (Bolden-Watson and Richelson 1993; Muth et al. 1986). As such, venlafaxine was predicted to have a better tolerability profile than the tricyclic antidepressants (TCAs). Several early randomized, controlled trials (RCTs) confirmed that venlafaxine had antidepressant effects comparable to those of TCAs, with fewer side effects attributable to anticholinergic and antihistaminergic activity (see, for example, T. R. Einarson et al. 1999). The initial formulation of venlafaxine—now known as venlafaxine immediate-release (IR)—was approved by the U.S. Food and Drug Administration (FDA) for treatment of depression in 1994. An extended-release (XR) formulation was introduced a little more than 3 years later. Generic formulations of venlafaxine IR began to be introduced in 2007.

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Sample questions:
1.
A 42-year-old man with recurrent major depressive disorder (MDD) is referred to you by his primary care physician for evaluation because the patient has not responded to two adequate trials of selective serotonin reuptake inhibitors (SSRIs). You decide to prescribe venlafaxine extended release (XR). Which of the following statements concerning the prescription of venlafaxine XR is true?
2.
The mechanism of action of both venlafaxine and desvenlafaxine is
3.
Although venlafaxine is approved by the U.S. Food and Drug Administration (FDA) only for the treatment of major depressive disorder, generalized anxiety disorder, social anxiety disorder, and panic disorder, double-blind and single-blind randomized, controlled clinical trials of venlafaxine monotherapy have shown it to be effective in all of the following additional conditions except
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