More than One-half of a Decade of Experience with Venlafaxine Dual Serotonin- Norepinephrine Reuptake Inhibitor

There are many telling reasons to assemble a special issue of Depression and Anxiety at this time on venlafaxine, the dual serotonin-norepinephrine reuptake inhibitor, that is currently approved in the United States for the treatment of major depression and generalized anxiety disorder. First, there has been increasing evidence largely compiled by Bech and his colleagues in Denmark that antidepressants that inhibit both norepinephrine and serotonin reuptake (SNRI) are more effective in severe and refractory depression than those that inhibit uptake of a single monoamine neurotransmitter. In addition, patients with major depression treated with dual reuptake inhibitors may achieve remission more frequently than those treated with single monoamine reuptake inhibitors. This is not a trivial point in view of the considerable morbidity associated with chronic depression. There is now convincing data not only of the potential suicide risk in partially treated depressed patients, but the emerging data base that suggests that depression is associated with a significantly increased risk for both the development of, and poor outcome after, both myocardial infarction and stroke. The present volume reviews in a comprehensive fashion the neurobiology of depression with a focus on the pathophysiologic involvement of serotonergic and noradrenergic systems, as well as the preclinical and clinical neuropharmacology of venlafaxine. Much emphasis is paid to summarize in a succinct manner the pharmacokinetics and drug–drug interaction profile of this agent, as well as its efficacy in the treatment of depression, severe depression, refractory depression, as well as geriatric depression. Moreover, particular consideration is given to the growing awareness of the remarkably high comorbidity of mood and anxiety disorders, and the efficacy of venlafaxine in these states. The use of venlafaxine in generalized anxiety disorder as well as in other psychiatric conditions is adequately reviewed, as is the use of this dual reuptake inhibitor in children and adolescents. Finally, the importance of measures of quality of life in assessing treatment response in mood and anxiety disorders is described, as well as pharmacoeconomic studies which seek to determine the cost utility of antidepressant treatment in this common and devastating set of conditions. There is little doubt that the introduction of venlafaxine has had a remarkable impact on clinical practice. I Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia