Venlafaxin ist kein SSRI, sondern ein SNRI, und das ist relevant

Zusammenfassung

Venlafaxin ist ein selektives Antidepressivum, indem es - wie selektiv-serotonerge Antidepressiva (SSRI) - frei von den anticholinergen, antihistaminergen, antiadrenergen und kardiotoxischen Nebenwirkungen der trizyklischen Antidepressiva ist. Venlafaxin hemmt aber - anders als die SSRI - nicht nur die synaptische Wiederaufnahme von Serotonin, sondern insbesondere in höherer Dosis auch die von Noradrenalin (sog. duales Wirkprinzip der selektiven Serotonin-Noradrenalin-Reuptake-Inhibition, SNRI). Gemäß mehrerer Meta-Analysen ist die Rate von Vollremissionen bei Depression unter Venlafaxin signifikant höher als unter SSRI. Dieser Überlegenheit liegt wahrscheinlich der duale Mechanismus zu Grunde. Venlafaxin ist als einziges Antidepressivum auch für die Indikation der Rückfall- und Rezidivprophylaxe formal zugelassen. Ob das duale Wirkprinzip auch hier Vorteile bietet, müsste durch Vergleichsstudien geprüft werden. Venlafaxin ist neben Paroxetin das einzige zur Behandlung der generalisierten Angststörung formal zugelassene Antidepressivum. Ob das duale Wirkprinzip in dieser Indikation Vorteile bietet, müsste auch hier durch Vergleichsstudien geprüft werden.

Summary

Venlafaxine is a selective antidepressant in that - like the selective serotonin reuptake inhibitors (SSRI) - it is free from the anticholinergic, antihistaminergic, antiadrenergic and cardiotoxic side-effects of tricyclic antidepressants. Venlafaxine, however, differs from the SSRIs by inhibiting not only the synaptic reuptake of serotonin but - especially at higher dosages - also that of norepinephrine (the so-called dual mechanism of selective serotonin-norepinephrine-reuptake-inhibition, SNRI). According to several meta-analyses the rate of full remissions of depression is significantly higher under venlafaxine than under SSRIs. This superiority is probably due to the dual mechanism of action. Venlafaxine is the only antidepressant formally approved for relapse and recurrence prevention. Further studies comparing venlafaxine to SSRIs are needed to test whether the dual mechanism is advantageous also in this indication. Venlafaxine is beside paroxetine the only antidepressant formally approved for generalized anxiety disorder. Again, further studies comparing venlafaxine to SSRIs are needed to test whether the dual mechanism is advantageous.

Key Words:

Venlafaxine - depression - efficacy - dual mechanism of action - response rate

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