Background. Knowledge about real-world use of duloxetine and venlafaxine XR to treat depression in the UK is limited. Aims. To identify predictors of duloxetine or venlafaxine XR initiation. Method. Adult depressed patients who initiated duloxetine or venlafaxine XR between January 1, 2006 and September 30, 2007 were identified in the UK’s General Practice Research Database. Demographic and clinical predictors of treatment initiation with duloxetine and venlafaxine XR were identified using logistic regression. Results. Patients initiating duloxetine ( ) were 4 years older than venlafaxine XR recipients ( ). Older age, preexisting unexplained pain, respiratory disease, and pre-period use of anticonvulsants, opioids, and antihyperlipidemics were associated with increased odds of initiating duloxetine compared to venlafaxine XR. Pre-period anxiety disorder was associated with decreased odds of receiving duloxetine. Conclusion. Initial treatment choice with duloxetine versus venlafaxine XR was primarily driven by patient-specific mental and medical health characteristics. General practitioners in the UK favor duloxetine over venlafaxine XR when pain conditions coexist with depression. 1. Introduction Major depressive disorder (MDD) is a mood disorder characterized by persistent feelings of sadness, a pervasive low mood, diminished ability to experience pleasure, and cognitive symptoms such as difficulty concentrating and impaired memory. In addition to the array of emotional and cognitive symptoms of depression, people with depression often have physical symptoms that do not respond well to treatment, such as frequent headaches, digestive problems, and chronic pain. Taken together, the symptoms of depression can lead to significant impairments in cognitive, physical, and social functioning. In the UK, the prevalence of depression is 2.6% among those aged 16–74, with a slightly higher rate among females [1]. A total of 1.24 million people were estimated having depression in England in 2007 [2]. A variety of pharmacologic treatments are available to alleviate the symptoms of depression, including tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), and dopamine reuptake inhibitors. Serotonin norepinephrine reuptake inhibitors (SNRIs), a relatively new class of antidepressant medications, have a selective enhancing effect on both serotonin and norepinephrine neurotransmission. Introduced in 1995 in the UK, venlafaxine XR is a SNRI indicated for major depressive disorder, generalized anxiety
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