The concept of resistant depression and therapeutic strategies, particularly with venlafaxine

About 30 % of depressed patients exhibit depression that is resistant to antidepressant treatment. This resistance may be primary or associated with a concomitant psychiatric or somatic disease. Venlafaxine has shown potent efficacy in certain severe depressions in in-patients and in patients presenting with resistant depression in an open-label study. If was considered of interest to compare, under double-blind, the efficacy of venlafaxine (200 to 300 mg/day) and that of paroxetine (30 to 40 mg/day) (for 6 weeks) in 123 patients presenting with major depression resistant to two correctly conducted antidepressant treatments in the course of an episode of depression of duration not exceeding 8 months. The patients were required not to present with organic disease, particularly endocrine disease. After 28 days of treatment, half of the patients receiving venlafaxine and one third of the patients receiving paroxetine showed a 50 % reduction in their total score on the Hamilton scale. In addition, the percentage of patients presenting with remission was significantly higher in the group receiving venlafaxine (42 %) compared to that receiving paroxetine (20 %). These results require confirmation over the long term and in other forms of resistant depression.