Abstract Introduction: Selective serotonin reuptake inhibitors act primarily on serotonin, whereas serotonin–norepinephrine reuptake inhibitors (SNRIs) modulate both serotonin and norepinephrine, potentially influencing their anxiolytic effects. Brain-derived neurotrophic factor (BDNF), a key mediator of neuroplasticity, may play a role in anxiety reduction, but comparative data across antidepressants remain limited. Objective: To compare the effects of desvenlafaxine and escitalopram on anxiety and somatic symptoms, examine correlations between serum BDNF and anxiety improvement, and evaluate whether BDNF predicts reduction in anxiety symptoms in patients with major depressive disorder (MDD) with comorbid anxiety. Methodology: In this randomized, open-label, parallel-group study (CTRI/2021/11/038260), patients with MDD (Hamilton Rating Scale for Depression HAM-D 8-23) and comorbid anxiety (Hamilton Anxiety Rating Scale HAM-A >17) received desvenlafaxine 50 mg ( n = 20) or escitalopram 10 mg ( n = 19) daily for 8 weeks. Depression, anxiety, and somatic symptoms were assessed using HAM-D, HAM-A, and somatic symptom scale-8 (SSS-8) scales. Serum BDNF was measured at baseline and week 8. Multiple regression included age, sex, and baseline HAM-A as covariates. Results: Of 54 screened, 39 patients completed the study. Both treatments significantly improved HAM-D, HAM-A, and SSS-8 scores. Desvenlafaxine showed greater improvement in somatic symptoms ( P = 0.012) and a higher rise in BDNF (113.5 ± 97.0 vs. 57.4 ± 70.7 pg/ml). In the desvenlafaxine group, BDNF change correlated strongly with HAM-A reduction ( r = −0.69, P = 0.001) and independently predicted anxiety improvement (β = −0.66, R 2 =0.50, P = 0.003). Conclusion: Only desvenlafaxine demonstrated a predictive relationship between BDNF increase and anxiety reduction, supporting BDNF’s potential as a biomarker for SNRI response.
Chindhalore et al. (Wed,) studied this question.