Desvenlafaxine succinate for major depressive disorder: a critical review of the evidence

Abstract

Desvenlafaxine succinate (DVS) is the succinate salt monohydrate of O-desmethylvenlafaxine, an active metabolite of venlafaxine. DVS is a serotonin–norepinephrine reuptake inhibitor (SNRI) like venlafaxine, but exhibits a differential serotonergic and noradrenergic activity profile. A sustained-release form of DVS is approved by the US FDA for the treatment of adult major depressive disorder (MDD). DVS has shown efficacy for the treatment of MDD in clinical trials with doses ranging from 50 to 400 mg/day. The 50–100 mg/day dose range is therapeutic, with lack of additional benefit shown at higher dosages and a significantly higher risk of side effects, especially at the 400 mg/day dosing. Advantages of DVS over other sSNRIs include its simple metabolism, lower risk of drug–drug interactions and lack of need for extensive titration to achieve therapeutic efficacy. Limitations with the use of DVS include its moderate efficacy in the treatment of MDD, a safety–tolerability profile similar to that of other SNRIs and the possibility of transient discontinuation symptoms with cessation of DVS treatment. DVS is a useful addition to the options available for the treatment of MDD in light of the limited efficacy of currently available antidepressants.

Keywords::

• desvenlafaxine
• DVS
• major depressive disorder
• MDD
• serotonin–norepinephrine-reuptake inhibitor
• SNRI

Acknowledgements

We gratefully acknowledge Andrew Winokur, MD, PhD (Professor of Psychiatry & Pharmacology at the University of Connecticut Health Center) for his valuable comments and critical review of the manuscript.

Financial & competing interests disclosure

The University of Connecticut Health Center (UCHC) was a site for some of the multicenter studies conducted with desvenlafaxine. J Kamath served as the principal investigator or co-investigator on some of the studies conducted at UCHC. The authors have no other affiliations with Wyeth Research Inc. and no other financial conflicts exist with Wyeth.

In preparation of the manuscript, authors requested and received copies of posters presented by Wyeth at national meetings. Per journal policy, Wyeth’s comments on the prepared manuscript were sought for scientific content/accuracy.

No writing assistance from Wyeth was utilized in the preparation of the manuscript.