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Second-Generation Antidepressants for Treating Adult Depression—An Update

Slide: 13 of 28

IImmediate-Release Versus Extended-Release Formulations of Second-Generation Antidepressants for Adults With MDD

There were five head-to-head trials that investigated the comparative efficacy of daily versus weekly dosing and immediate-release versus extended-release formulations. Two of these trials compared fluoxetine daily with fluoxetine weekly; two good-quality trials assessed paroxetine IR (immediate release) versus paroxetine CR (controlled release); and one trial compared venlafaxine IR with venlafaxine XR (extended release). There were no studies on other medications, such as bupropion or fluvoxamine, that are available as both immediate-release and extended-release formulations.

Key Points

  • Five head-to-head trials investigated the comparative efficacy of daily versus weekly dosing and immediate-release versus extended-release formulations.
  • Two randomized controlled trials (RCTs) reported similar rates of maintenance of response and relapse for patients treated with fluoxetine daily or fluoxetine weekly during the continuation phase of therapy for major depressive disorder (MDD). The strength of evidence is moderate.
  • One RCT and a pooled analysis of two identical RCTs did not find any differences in response rates in patients treated with paroxetine IR or paroxetine XR for acute-phase MDD. The strength of evidence is moderate.
  • One RCT reported higher response rates for patients on venlafaxine XR than those on venlafaxine IR. The strength of evidence is low.