Efficacy, tolerability, and acceptability of bupropion for major depressive disorder: a meta-analysis of randomized–controlled trials comparison with venlafaxine

Figures & data

Figure 1 Flow diagram of study.

Abbreviation: E-CTR, Eropean Clinical Trials Register.

Table 1 Important characteristics of controlled trials of bupropion versus venlafaxine in major depressive disorder

Study	Number of patients	Age of subjects (years)	Study duration (weeks)	Drug/dose	Diagnostic criteria	Included criteria	Response criteria	Remission criteria	Outcome measures
Thase^Citation37	342	18 or more	15–16	Bupropion XL*/150 mg/day and 450 mg/day Venlafaxine XR**/75–225 mg/day	DSM IV-TR	HAM-D-17 ≥ 17 and CGI-S ≥4	≥50% reduction in HAM-D-17	HAM-D-17 ≤7	HAM-D-17, CGI-S, CGI-I, CSFQ
Hewett^Citation40	374	18–64	14	Bupropion XL*/150 mg/day and 300 mg/day Venlafaxine XR**/75–150 mg/day	DSM IV	HAM-D-18 ≥ 17 and CGI-S ≥4	≥50% reduction in MADRS	MADRS ≤ 11	MADRS, CGI-S, CGI-I, HAM-A MEI, Q-LES-Q-SF, SDS, CSFQ
Hewett^Citation41	401	18–64	Up to 14	Bupropion XL*/150 mg/day and 300 mg/day Venlafaxine XR**/75–150 mg/day	DSM IV	HAM-D-18 ≥ 17 and CGI-S ≥4	≥50% reduction in MADRS	MADRS ≤ 11	MADRS, CGI-S, CGI-I, HAM-A MEI, Q-LES-Q-SF, SDS, CSFQ

Notes:

* Wellbutrin XR®, GlaxoSmithKline, London, UK

** Effexor XR®, Wyeth-Ayers, Philidelphia, PA, USA.

Abbreviations: CGI-I, Clinical Global Impression-Improvement scale; CGI-S, Clinical Global Impression-Severity of Illness; CSFQ, Changes in Sexual Functioning Questionnaire; DSM IV-TR, Diagnostic and Statistical Manual of Mental Disorders fourth edition text revision; HAM-A, Hamilton Rating Scale for Anxiety; HAM-D-17, 17-item Hamilton Rating Scale for Depression; HAM-D-18, 18-item Hamilton Rating Scale for Depression; MADRS, Montgomery-Asberg Depression Rating Scale; MEI, 18-item Motivation and Energy Inventory; Q-LES-Q-SF, Short Form Quality of Life Enjoyment Satisfaction Questionnaire; SDS, Sheehan Disability Scale.

Table 2 Risk of bias summary of controlled trials of bupropion versus venlafaxine in major depressive disorder

Study	Issues of bias
	1	2	3	4	5	6	7	8
Thase^Citation37	U	L	L	L	U	L	L	L
Hewett^Citation40	U	L	L	L	U	L	L	L
Hewett^Citation41	U	L	L	L	U	L	L	L

Notes: 1 = Adequate sequence generation; 2 = Allocation concealment; 3 = Blinding (subjective outcome); 4 = Dropout data addressed; 5 = Free of selective reporting; 6 = Free of other bias; 7 = Baseline similarity; 8 = Itention-to-treat analysis or modifed intention-to-treat analysis.

Abbreviations: L, low risk of bias; U, unclear risk of bias.

Figure 2 Comparison of the mean changes from baseline of depression rating scales (95% confidence interval) in patients with MDD: bupropion versus venlafaxine.

Notes: Heterogeneity: Tau²
= 0.02; Chi²
= 6.11; df = 2 (P = 0.05); I²
= 67%. Test for overall effect: Z = 0.46 (P = 0.64).
Abbreviations: CI, confidence interval; IV, inverse variance; MDD, major depressive disorder; SD, standard deviation; Std, standard; df, degrees of freedom.

Figure 3 Comparison of relative risk (95% confidence interval) for clinical response rates in patients with MDD: bupropion versus venlafaxine.

Notes: Heterogeneity: Tau²
= 0.01; Chi²
= 4.65; df = 2 (P = 0.10); I²
= 57%. Test for overall effect: Z = 1.04 (P = 0.30).
Abbreviations: CI, confidence interval; df, degrees of freedom; M-H, Mantel-Haenszel; MDD, major depressive disorder.

Figure 4 Comparison of relative risk (95% confidence interval) for clinical remission rates in patients with MDD: bupropion versus venlafaxine.

Notes: Heterogeneity: Tau²
= 0.03; Chi²
= 6.70, df = 2 (P = 0.04); I²
= 70%. Test for overall effect: Z = 0.27 (P = 0.79).
Abbreviations: CI, confidence interval; df, degrees of freedom; M-H, Mantel-Haenszel; MDD, major depressive disorder.

Figure 5 Comparison of the mean changes from baseline of the CSFQ (95% confidence interval) in patients with MDD: bupropion versus venlafaxine.

Notes: Heterogeneity: Tau²
= 0.61; Chi²
= 3.34, df = 2 (P = 0.19); I²
= 40%. Test for overall effect: Z = 1.90 (P = 0.06).
Abbreviations: CI, confidence interval; df, degrees of freedom; CSFQ, Changes in Sexual Functioning Questionnaire; IV, inverse variance; MDD, major depressive disorder; SD, standard deviation.

Thase ME Clayton AH Haight BR Thompson AH Modell JG Johnston JA A double-blind comparison between bupropion XL and venlafaxine XR: sexual functioning, antidepressant efficacy, and tolerability J Clin Psychopharmacol 2006 26 5 482 488 16974189

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