Comparison of efficacy, safety and brain derived neurotrophic factor (BDNF) levels in patients of major depressive disorder, treated with fluoxetine and desvenlafaxine

• BDNF level is a potential biomarker toward response to antidepressants.
• Major depressive disorder (MDD) was treated with fluoxetine or desvenlafaxine.
• Randomized, open-label study assessed efficacy, safety and plasma BDNF levels.
• Both medicines comparably improved HAM-D scores and tolerated well in depression.
• Both the antidepressant agents significantly increased BDNF levels.

This randomized, open label, prospective, observational study compared clinical efficacy, safety alongwith plasma BDNF levels in outpatients of depression treated with fluoxetine and desvenlafaxine. Patients (aged 18–60 years) with moderate to severe major depressive disorder (MDD) diagnosed by DSM-IV criteria, and Hamilton Rating Scale for Depression (HAM-D) score ≥14, who were prescribed fluoxetine or desvenlafaxine were included (n = 30 in each group). Patients were followed up for 12 weeks for evaluation of clinical efficacy, safety along with BDNF levels. In the fluoxetine group, HAM-D scores at the start of treatment was 19 ± 4.09 which significantly (p < 0.05) reduced to 9.24 ± 3.98 at 12 weeks. In the desvenlafaxine group, HAM-D scores at the start of treatment was 18 ± 3.75 which significantly (p < 0.05) reduced to 10 ± 3.75 at 12 weeks. The BDNF levels in the fluoxetine group were 775.32 ± 30.38 pg/ml at the start of treatment which significantly (p < 0.05) increased to 850.3 ± 24.92 pg/ml at 12 weeks. The BDNF levels in the desvenlafaxine group were 760.5 ± 28.53 pg/ml at the start of treatment which significantly (p < 0.05) increased to 845.8 ± 32.82 pg/ml at 12 weeks. Both the antidepressants were found to be safe and well tolerated. The efficacy and the safety profile of desvenlafaxine is comparable to fluoxetine in patients of MDD. BDNF levels were significantly increased post-treatment with both the antidepressive agents. Whether BDNF may have a prognostic value in predicting treatment response to antidepressant drugs needs to be investigated in a larger patient population.