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By David S Baldwin; Jon Birtwistle

ISBN-10: 1850709424

ISBN-13: 9781850709428

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Care settings, and in patients with generalized anxiety disorder (GAD). A review of the findings of randomized controlled trials indicates that the short-term efficacy of venlafaxine is at least as good as that of the TCAs clomipramine and imipramine and the SSRIs paroxetine and fluoxetine18. In longer-term treatment, pooled analysis suggests that venlafaxine is efficacious in preventing relapse of depression18. A recent meta-analysis of the findings of comparator-controlled studies suggests that venlafaxine is significantly more efficacious than SSRIs in short-term treatment19, and treatment with dual-acting drugs such as venlafaxine may be preferable to SSRI treatment in hospitalized depressed patients1.

The probability of clinically significant increases in blood pressure (rises greater than 15 mmHg, to a diastolic pressure greater than 105 mmHg), increases with dose, being 13% at doses above 300 mg per day22. Blood pressure should be monitored in those on doses above 200 mg per day, and venlafaxine should not be given to patients with hypertension. Discontinuation effects can occur when patients stop venlafaxine abruptly, particularly after daily doses of 150 mg or more: typically symptoms arise within 2 days, and resolve within a week of stopping treatment.

31). It has antagonist actions at 5-HT2 receptors, but its active metabolite m-chlorophenylpiperazine (m-CPP) is a 5-HT receptor agonist. Therefore the precise balance of effects on 5-HT receptors during treatment is difficult to determine. Trazodone has low cardiotoxicity and is less toxic in overdose than tricyclic antidepressants. Anticholinergic side-effects are also lower but there is an increased incidence of drowsiness and nausea (particularly if taken on an empty stomach). 32. A review of several placebo-controlled studies has shown that trazodone in doses of 150–600 mg is superior to placebo in the treatment of depressed patients46.

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An atlas of depression by David S Baldwin; Jon Birtwistle

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