Desvenlafaxine in the treatment of major depression: an updated overview

ABSTRACT

Introduction: Major depressive disorder (MDD) remains one of the most prevalent mental health conditions. It is a chronic, relapsing condition and despite multiple treatment options, many patients fail to achieve remission of symptoms. Inadequacy of treatment has stimulated the search for agents with significant therapeutic advantages.

Areas covered: This review examines literature concerning the use of desvenlafaxine in the treatment of MDD published since a previous analysis in this journal in 2014. Published papers were identified via a PubMed and Web of Science search and excluded congress presentations. Results from clinical trials in MDD, systematic reviews, and post hoc analyses in patient subgroups, are reviewed.

Expert opinion: Desvenlafaxine was an effective antidepressant with favorable safety and tolerability in adults. Efficacy was demonstrated in the subgroup of peri- and post-menopausal women with MDD but not in children and adolescents. There is a relatively low potential for drug–drug interactions due to its metabolic profile. Hepatic impairment does not significantly alter dose requirements, whereas severe renal disease requires some adjustments of dose. Desvenlafaxine maybe suitable in patients with comorbid physical illnesses. Desvenlafaxine can be a first line consideration for the treatment of cases of MDD uncomplicated by medical comorbidities.

KEYWORDS:

• Desvenlafaxine
• major depressive disorder
• mechanism
• pharmacokinetics
• drug–drug interaction
• treatment efficacy
• adverse drug events
• children
• adolescents

Article Highlights

• Desvenlafaxine is a serotonin-noradrenaline reuptake inhibitor (SNRI) antidepressant approved for the treatment of major depressive disorder in adults.

• Recent studies have evaluated the efficacy for the treatment of depression in children, adolescents and peri- and post-menopausal women.

• Data suggest that the drug is not effective in children and adolescents.

• In peri-and post-menopausal women the drug exerts a significantly superior effect to placebo in short term studies, with no meaningful clinical differences based on menopausal status.

• The drug has a side effect profile similar to that of other SNRI antidepressants and is generally well tolerated in the therapeutic range of 50 -100mg/day.

• Metabolism of the drug by UGT enzymes suggests a low potential interaction profile with other commonly prescribed medications.

• Further evaluations are necessary to evaluate it useful in special population such as the “old-old” and frail elderly.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Box 1. Drug summary box

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Additional information

Funding

This manuscript has not been funded.